Stapling instrument comprising a tissue drive

ABSTRACT

A surgical stapler for stapling the tissue of a patient is disclosed. The surgical stapler comprises a handle, a shaft extending from the handle, a plurality of staple cartridges, and an end effector comprising a tissue compression surface and an anvil comprising staple forming pockets, wherein the anvil is movable toward the tissue compression surface during a closing motion. The surgical stapler further comprises an anvil closing system configured to move the anvil through the closing motion, a staple firing system configured to deploy the staple cartridges along a path, and means for gripping the patient tissue and creating relative movement between the end effector and the patient tissue to re-position the end effector along the path.

BACKGROUND

The present invention relates to surgical instruments and, in variousarrangements, to surgical stapling and cutting instruments and staplecartridges for use therewith that are designed to staple and cut tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

Various features of the embodiments described herein, together withadvantages thereof, may be understood in accordance with the followingdescription taken in conjunction with the accompanying drawings asfollows:

FIG. 1 is a perspective view of a surgical stapling instrument inaccordance with at least one embodiment;

FIG. 2 is a cross-sectional view of the stapling instrument of FIG. 1taken along line 2-2 in FIG. 1;

FIG. 3 is a partial perspective view of a drive system of the staplinginstrument of FIG. 1;

FIG. 4 is a plan view of the drive system of FIG. 3;

FIG. 5 is an elevational view of the drive system of FIG. 3 illustratedin a first operational configuration;

FIG. 6 is a side elevational view of the drive system of FIG. 3illustrated in the first operational configuration of FIG. 5;

FIG. 7 is a side elevational view of the drive system of FIG. 3illustrated in a second operational configuration;

FIG. 8 is a partial perspective view of a surgical stapling instrumentin accordance with at least one embodiment;

FIG. 9 is a partial perspective view of a surgical stapling instrumentin accordance with at least one embodiment;

FIG. 10 is a perspective view of a handle housing of the staplinginstrument of FIG. 8;

FIG. 11 is a perspective view of a battery in accordance with at leastone embodiment;

FIG. 12 is a perspective view of a handle of the stapling instrument ofFIG. 1;

FIG. 13 is a partial perspective view of a surgical stapling instrumentincluding a display in accordance with at least one embodiment;

FIG. 14 depicts a status control on the display of FIG. 13;

FIG. 15 depicts a speed control on the display of FIG. 13;

FIG. 16 depicts a fault threshold control on the display of FIG. 13;

FIG. 17 depicts a direction control on the display of FIG. 13;

FIG. 18 depicts the display of FIG. 13 and the speed control of FIG. 15;

FIG. 19 depicts the display of FIG. 13 and a speed control;

FIG. 20 depicts the display of FIG. 13 and a staple path control beingused to alter the staple firing path of the stapling instrument;

FIG. 21 depicts the display of FIG. 13 and the staple path control ofFIG. 21 being used to control the staple firing path of the staplinginstrument;

FIG. 22 depicts the display of FIG. 13 and a control for stopping thestapling instrument along the staple firing path;

FIG. 23 depicts a surgical instrument system including an external, oroff-board, display in accordance with at least one embodiment;

FIG. 24 depicts a display of a surgical stapling instrument inaccordance in at least one embodiment;

FIG. 25 depicts the display of FIG. 24 being used to change a staplefiring path when creating a stomach sleeve during a stomach reductionprocedure;

FIG. 26 depicts a joystick being used to change a staple firing path onthe display of FIG. 24;

FIG. 27 depicts the stapling instrument being guided along a staplefiring path;

FIG. 28 depicts the stomach of a patient;

FIG. 29 is a cross-sectional view of the stomach of a patient;

FIG. 30 is a cross-sectional view of a target inserted into the stomachof FIG. 29;

FIG. 31 is a cross-sectional view of the stomach of a patient which isthinner than the stomach of FIG. 29;

FIG. 32 is a cross-sectional view of a target inserted into the stomachof FIG. 31;

FIG. 33 depicts various anatomical features which can be referencedduring a stomach sleeve procedure;

FIG. 34 is a partial elevational view of a surgical stapling instrumentcomprising a shaft, an end effector, and an articulation joint inaccordance with at least one embodiment;

FIG. 35 is a partial elevational view of the stapling instrument of FIG.34 illustrating the end effector in an articulated position;

FIG. 36 is a bottom cross-sectional view of an end effector of asurgical stapling instrument in accordance with at least one embodiment;

FIG. 37 is a partial cross-sectional view of a surgical staplinginstrument comprising a tissue drive system in accordance with at leastone embodiment;

FIG. 38 is a partial cross-sectional view of the stapling instrument ofFIG. 37 illustrating the tissue drive system engaged with the tissue ofa patient;

FIG. 39 is a partial cross-sectional view of the stapling instrument ofFIG. 37 illustrating the tissue drive system pushing the patient tissuein a first direction;

FIG. 40 is a partial cross-sectional view of the stapling instrument ofFIG. 37 illustrating the tissue drive system pushing the patient tissuein a second direction;

FIG. 41 is a partial cross-sectional view of the stapling instrument ofFIG. 37 illustrating the tissue drive system being disengaged from thepatient tissue;

FIG. 42 is a partial elevational view of a drive system including asynchronizing mechanism in accordance with at least one embodiment;

FIG. 43 illustrates the synchronizing mechanism of FIG. 42 actuating anend effector drive system;

FIG. 44 illustrates a drive system configured to reciprocatingly drive aplurality of end effector drive system;

FIG. 45 depicts plots of two synchronized end effector drives;

FIG. 46 is a table illustrating the synchronization of four end effectordrives;

FIGS. 47A-47G illustrate the operational steps of a surgical staplinginstrument in accordance with at least one embodiment;

FIG. 48 is a table illustrating the synchronization of the end effectordrives of a surgical stapling instrument in accordance with at least oneembodiment;

FIG. 49 is a module for operating a surgical stapling instrument inaccordance with at least one embodiment;

FIG. 50 is a partial perspective view of an end effector including atissue drive system in accordance with at least one embodimentillustrated being extended;

FIG. 51 is a partial perspective view of the tissue drive system of FIG.50 being retracted;

FIG. 52 is a partial cross-sectional view of the end effector of FIG. 50illustrating the tissue drive system in a retracted configuration;

FIG. 53 is a partial cross-sectional view of the end effector of FIG. 50illustrating the tissue drive system in a lowered configuration;

FIG. 54 is a partial cross-sectional view of the end effector of FIG. 50illustrating the tissue drive system being extended;

FIG. 55 is a partial cross-sectional view of the end effector of FIG. 50illustrating teeth of the tissue drive system in a protrudedconfiguration;

FIG. 56 is a partial cross-sectional view of the end effector of FIG. 50illustrating the drive system being retracted;

FIG. 57 is a partial perspective view of a tissue drive system inaccordance with at least one embodiment;

FIG. 58 is a partial perspective view of the tissue drive system of FIG.57 in an extended configuration;

FIGS. 59A-59D illustrate the operational steps of a tissue drive systemof a surgical stapling instrument in accordance with at least oneembodiment;

FIGS. 60A-60D further illustrate the operational steps of the tissuedrive system of FIGS. 59A-59D;

FIG. 61 is a partial perspective view of a surgical stapling instrumentincluding a tissue drive system in accordance with at least oneembodiment;

FIG. 62 is a partial perspective view of the tissue drive system of FIG.61 in an extended configuration;

FIG. 63 is a partial cross-sectional perspective view of a surgicalstapling instrument comprising a tissue drive system in accordance withat least one embodiment;

FIG. 64 is a bottom cross-sectional plan view of the stapling instrumentof FIG. 63;

FIG. 65 is a partial cross-sectional view of a surgical staplinginstrument including a vacuum system in accordance with at least oneembodiment;

FIG. 66 is a partial detail view of a tissue drive system of thestapling instrument of FIG. 65;

FIG. 67 is a partial cross-sectional view of the stapling instrument ofFIG. 65 illustrating tissue being pulled into the end effector of thestapling instrument;

FIG. 68 is a partial detail view of the tissue drive system of FIG. 66;

FIG. 69 is a partial cross-sectional view of the stapling instrument ofFIG. 65 illustrating the tissue being released;

FIG. 70 is a partial cross-sectional view of a surgical staplinginstrument comprising a vacuum system in accordance with at least oneembodiment;

FIG. 71 is a partial cross-sectional view of the stapling instrument ofFIG. 70 illustrating first and second drive feet of the staplinginstrument in a retracted configuration;

FIG. 72 is a partial cross-sectional view of the stapling instrument ofFIG. 70 illustrating the first drive foot in an extended position;

FIG. 73 is a vacuum manifold of the stapling instrument of FIG. 70 influid communication with the first drive foot;

FIG. 74 is a partial perspective view of a surgical stapling instrumentin accordance with at least one embodiment;

FIGS. 75A-75D depict the operational steps of a surgical staplinginstrument in accordance with at least one embodiment;

FIG. 76 is a partial cross-sectional perspective view of a surgicalstapling instrument in accordance with at least one embodiment;

FIGS. 77A-77D depict the operational steps for steering the staplinginstrument of FIG. 76;

FIG. 78 is a cross-sectional end view of a surgical stapling instrumentin accordance with at least one embodiment;

FIG. 79 is a partial elevational view of a surgical stapling instrumentin accordance with at least one embodiment comprising a tissue drive;

FIG. 79A illustrates the position of a foot of the tissue drivecorresponding with FIG. 79;

FIG. 80 is a partial elevational view of the stapling instrument of FIG.79 illustrating the foot being extended;

FIG. 80A illustrates the position of the foot of the tissue drivecorresponding with FIG. 80;

FIG. 81 is a partial elevational view of the stapling instrument of FIG.79 illustrating the foot in an extended configuration;

FIG. 81A illustrates the position of the foot of the tissue drivecorresponding with FIG. 81;

FIG. 82 is a partial elevational view of the stapling instrument of FIG.79 illustrating the foot being retracted;

FIG. 82A illustrates the position of the foot of the tissue drivecorresponding with FIG. 82;

FIG. 83 is a partial cross-sectional view of the tissue drive of thestapling instrument of FIG. 79;

FIG. 84 illustrates the kinematics of the tissue drive of the staplinginstrument of FIG. 79;

FIG. 85 illustrates a cam capable of producing the kinematics of FIG.84;

FIG. 86 is a perspective view of a cam capable of producing thekinematics of FIG. 84;

FIG. 87 is a partial perspective view of a surgical stapling instrumentincluding a tissue drive in accordance with at least one embodiment;

FIG. 88 depicts a tissue drive of a surgical stapling instrument inaccordance with at least one embodiment;

FIG. 89 depicts the tissue drive of FIG. 88 in an extendedconfiguration;

FIGS. 90A-90D depict the operational steps of a surgical staplinginstrument including a tissue drive in accordance with at least oneembodiment;

FIGS. 91A-91D depict the operational steps of a surgical staplinginstrument including a tissue drive in accordance with at least oneembodiment;

FIG. 92 depicts a tissue drive of a surgical stapling instrument inaccordance with at least one embodiment;

FIG. 93 depicts the tissue drive of FIG. 92 in an extendedconfiguration;

FIG. 94 is a partial cross-sectional perspective view of a surgicalstapling instrument in accordance with at least one embodiment;

FIG. 95 is a partial elevational view of a surgical stapling instrumentcomprising a tissue cutting member in accordance with at least oneembodiment;

FIG. 96 depicts the tissue cutting member of FIG. 95 being moved througha tissue cutting stroke;

FIG. 97 is partial perspective view of a surgical stapling instrument inaccordance with at least one embodiment;

FIG. 98 is a perspective view of two connected staples in accordancewith at least one embodiment;

FIG. 99 is a partial perspective view of the staples of FIG. 98 beingseparated;

FIG. 100 is a partial cross-sectional view of a staple firing system ofthe stapling instrument of FIG. 97 including a staple firing chamber inaccordance with at least one embodiment;

FIG. 101 illustrates a staple being fired by the staple firing system ofFIG. 100;

FIG. 102 illustrates another staple being loaded into the staple firingchamber of FIG. 100;

FIG. 103 is a bottom cross-sectional end view of the stapling instrumentof FIG. 97;

FIG. 104 is a partial cross-sectional perspective view of a surgicalstapling instrument in accordance with at least one embodiment;

FIGS. 105A-105D depict the operational steps of the stapling system ofFIG. 104;

FIG. 106 is a partial perspective view of a surgical stapling instrumentin accordance with at least one embodiment;

FIG. 107 is an exploded perspective view of a staple clip for use withthe stapling instrument of FIG. 106;

FIG. 108 is a plan view of a staple clip in accordance with at least oneembodiment;

FIG. 109 is an end view of the staple clip of FIG. 108 positioned in asurgical stapling instrument;

FIG. 110 is a perspective view of the staple clip of FIG. 108;

FIG. 111 is an end view of a staple clip in accordance with at least oneembodiment positioned in a surgical stapling instrument;

FIG. 112 is a perspective view of the staple clip of FIG. 111;

FIG. 113 is an end view of a staple clip in accordance with at least oneembodiment positioned in a surgical stapling instrument;

FIG. 114 is a perspective view of the staple clip of FIG. 113;

FIG. 115 is a partial plan view of a staple strip in an unfoldedconfiguration in accordance with at least one embodiment;

FIG. 116 is an end view of the staple strip of FIG. 115 in its unfoldedconfiguration;

FIG. 117 is an end view of the staple strip of FIG. 115 in a foldedconfiguration;

FIG. 118 is a perspective of the staple strip of FIG. 115 beingdeployed;

FIG. 119 is a perspective view of a staple cluster in accordance with atleast one embodiment;

FIG. 120 is a partial perspective view of the staple cluster of FIG. 119being loaded into a surgical stapling instrument;

FIG. 121 is a partial perspective view of a surgical stapling instrumentcomprising deployable staple clusters in accordance with at least oneembodiment;

FIG. 122 is a partial perspective view of a surgical stapling instrumentcomprising a tissue drive in accordance with at least one embodiment;

FIG. 123 is a partial perspective view of the stapling instrument ofFIG. 122 illustrating the tissue drive in an extended configuration;

FIG. 124 depicts a cross-sectional width of a distal head of thestapling instrument of FIG. 122;

FIG. 125 is a cross-sectional view of a tissue gripping surface of thetissue drive of FIG. 122;

FIG. 126 is a cross-sectional end view of a surgical stapling instrumentincluding a tissue drive in accordance with at least one embodimentillustrated in an extended configuration;

FIG. 127 is a cross-sectional end view of the stapling instrument ofFIG. 126 illustrating the tissue drive in a retracted configuration;

FIG. 128 depicts a firing drive of a surgical stapling instrument inaccordance with at least one embodiment illustrated in an unfiredconfiguration;

FIG. 128A depicts a tissue drive of the stapling instrument of FIG. 128illustrated in an extended configuration;

FIG. 129 depicts the firing drive of FIG. 128 illustrated in a firedconfiguration;

FIG. 129A depicts the tissue drive of FIG. 128A in a retractedconfiguration;

FIG. 130 depicts the firing drive of FIG. 128 illustrated in its unfiredconfiguration;

FIG. 130A depicts the tissue drive of FIG. 128A in its retractedconfiguration;

FIG. 131 is a perspective view of a staple loading system of a surgicalstapling instrument in accordance with at least one embodiment;

FIG. 132 is a plan view of the staple loading system of FIG. 131;

FIG. 133 is a partial elevational view of the staple loading system ofFIG. 131;

FIG. 134 is a partial cross-sectional view of the stapling instrument ofFIG. 131 illustrated in an unfired configuration;

FIG. 135 is a partial cross-sectional view of the stapling instrument ofFIG. 131 illustrated in a fired configuration;

FIG. 136 is a partial cross-sectional view of the stapling instrument ofFIG. 131 being retracted into its unfired configuration;

FIG. 137 is a partial cross-sectional view of the stapling instrument ofFIG. 131 illustrated in its unfired configuration;

FIG. 138 depicts a staple pattern that can be produced by a surgicalstapling instrument in accordance with at least one embodiment;

FIG. 139 depicts a staple pattern that can be produced by a surgicalstapling instrument in accordance with at least one embodiment;

FIG. 140 illustrates a surgical stapling instrument in accordance withat least one embodiment;

FIG. 141 illustrates the operational steps that the stapling instrumentof FIG. 140 uses to manufacture and deploy staples;

FIG. 142 depicts a staple firing line in the stomach of a patient;

FIG. 143 depicts a progression of staple firings in accordance with atleast one embodiment;

FIGS. 144-146 illustrate the stapling instrument of FIG. 1 being usedduring a surgical procedure;

FIG. 147 illustrates a surgical stapling instrument in accordance withat least one embodiment being used during a surgical procedure;

FIG. 148 is a partial elevational view of the surgical staplinginstrument of FIG. 147;

FIG. 149 is a partial perspective view of the stapling instrument ofFIG. 147 in a first configuration;

FIG. 150 is a partial perspective view of the stapling instrument ofFIG. 147 in a second configuration;

FIG. 151 depicts a potential outcome of a stomach sleeve procedure usingthe surgical stapling instruments disclosed herein;

FIG. 152 depicts a guide inserted into the stomach of a patient;

FIG. 153 depicts a guide being used to define a staple firing path inthe patient's stomach;

FIG. 154 depicts the guide of FIG. 153 being used to create a stomachsleeve during a gastric bypass procedure;

FIG. 155 is a partial cross-sectional view of the guide of FIG. 153;

FIG. 156 is a partial cross-sectional view of a guide in accordance withat least one embodiment illustrated with some components removed;

FIG. 157 is a schematic of the guide of FIG. 153;

FIG. 158 is a perspective view of a surgical stapling system comprisingloadable staple cartridges in accordance with at least one embodiment;

FIG. 159 depicts certain operational components of the stapling systemof FIG. 158;

FIG. 160 is an end view of a surgical stapling instrument comprising aprojector system including two lenses in accordance with at least oneembodiment;

FIG. 161 illustrates the stapling instrument of FIG. 160 being usedduring a surgical procedure;

FIG. 162 illustrates a surgical stapling system including a projector inaccordance with at least one embodiment;

FIG. 163 illustrates a surgical stapling system comprising a visionsystem and a projection system in accordance with at least oneembodiment;

FIG. 164 illustrates the projector system of the stapling system of FIG.163 being used;

FIG. 165 illustrates a projected image on the tissue of a patient inaccordance with at least one embodiment;

FIG. 166 illustrates a staple firing path projected onto the tissue of apatient in accordance with at least one embodiment;

FIG. 167 illustrates a surgical stapling instrument comprising a firstprojector configured to project a first part of a staple firing pathonto the tissue of a patient and a second projector configured toproject a second part of the staple firing path onto the tissue of apatient in accordance with at least one embodiment;

FIG. 168 is a partial elevational view of a surgical stapling instrumentcomprising an articulatable end effector in accordance with at least oneembodiment;

FIG. 169 is a partial elevational view of the surgical staplinginstrument of FIG. 168;

FIG. 170 is a partial elevational view of a surgical stapling instrumentcomprising an articulatable end effector and a dampener configured toreduce unintentional movement of the end effector in accordance with atleast one embodiment;

FIG. 171 is a partial elevational view of a surgical stapling instrumentincluding an end effector dampener in accordance with at least oneembodiment;

FIG. 172 illustrates the stapling instrument of FIG. 171 being used in asurgical procedure;

FIG. 173 illustrates the stapling instrument of FIG. 171 being used in asurgical procedure;

FIG. 174 illustrates a staple firing path created by a surgical staplinginstrument comprising a longitudinal end effector;

FIG. 175 illustrates a staple firing path created by a surgical staplinginstrument disclosed herein;

FIG. 176 illustrates a staple firing path created by a surgical staplinginstrument comprising a longitudinal end effector;

FIG. 177 illustrates a staple firing path created by a surgical staplinginstrument disclosed herein;

FIG. 178 illustrates a staple firing path created by a surgical staplinginstrument comprising a longitudinal end effector;

FIG. 179 illustrates a staple firing path created by a surgical staplinginstrument disclosed herein;

FIG. 180 is a perspective view of a handle of a surgical instrument inaccordance with at least one embodiment;

FIG. 181 is a perspective view of the handle of the surgical instrumentof FIG. 180 enclosed in a sterile barrier;

FIG. 182 is a partial cross-sectional view of the sterile barrier and atouch-sensitive display of the handle of FIG. 181;

FIG. 183 is a plan view of the touch-sensitive display of FIG. 182illustrating a grid of electrodes, wherein a plurality of pixels isactivated; and

FIG. 184 is a graph depicting a relationship between the location of theactive pixels of FIG. 183 and the capacitance detected by thetouch-sensitive display of FIG. 182.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate various embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

Applicant of the present application owns the following U.S. patentapplications that were filed on even date herewith and which are eachherein incorporated by reference in their respective entireties:

U.S. patent application Ser. No. ______, entitled CONTINUOUS USESELF-PROPELLED STAPLING INSTRUMENT; Attorney Docket No.END8299USNP/170206M;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING SPEED CONTROL; Attorney Docket No. END8300USNP/170208;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING A PROJECTOR; Attorney Docket No. END8310USNP/170207;

U.S. patent application Ser. No. ______, entitled STAPLE INSTRUMENTCOMPRISING A FIRING PATH DISPLAY; Attorney Docket No. END8301USNP/170209;

U.S. patent application Ser. No. ______, entitled SELF-GUIDING STAPLINGINSTRUMENT; Attorney Docket No. END8311USNP/170210;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCONFIGURED TO DETERMINE FIRING PATH; Attorney Docket No.END8302USNP/170211;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING AN END EFFECTOR DAMPENER; Attorney Docket No.END8304USNP/170212;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING SYNCHRONIZED DRIVE SYSTEMS; Attorney Docket No.END8305USNP/170213;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING A TISSUE GRASPING SYSTEM; Attorney Docket No.END8307USNP/170215;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING SEQUENCED SYSTEMS; Attorney Docket No. END8308USNP/170216;

U.S. patent application Ser. No. ______, entitled STAPLING INSTRUMENTCOMPRISING A STAPLE FEEDING SYSTEM; Attorney Docket No.END8309USNP/170217;

U.S. patent application Ser. No. ______, entitled SURGICAL STAPLERCOMPRISING STORABLE CARTRIDGES HAVING DIFFERENT STAPLE SIZES; AttorneyDocket No. END8330USNP/170233;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTHAVING A DISPLAY COMPRISING IMAGE LAYERS; Attorney Docket No.END8331USNP/170235;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING A DISPLAY; Attorney Docket No. END8332USNP/170236;

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING AN ARTICULATABLE DISTAL HEAD; Attorney Docket No.END8333USNP/170232; and

U.S. patent application Ser. No. ______, entitled SURGICAL INSTRUMENTCOMPRISING A PIVOTABLE DISTAL HEAD; Attorney Docket No.END8334USNP/170234.

Applicant of the present application owns the following U.S. patentapplications that were filed on Dec. 19, 2017 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/847,306, entitled METHOD FORDETERMINING THE POSITION OF A ROTATABLE JAW OF A SURGICAL INSTRUMENTATTACHMENT ASSEMBLY;

U.S. patent application Ser. No. 15/847,297, entitled SURGICALINSTRUMENTS WITH DUAL ARTICULATION DRIVERS;

U.S. patent application Ser. No. 15/847,325, entitled SURGICAL TOOLSCONFIGURED FOR INTERCHANGEABLE USE WITH DIFFERENT CONTROLLER INTERFACES;

U.S. patent application Ser. No. 15/847,293, entitled SURGICALINSTRUMENT COMPRISING CLOSURE AND FIRING LOCKING MECHANISM;

U.S. patent application Ser. No. 15/847,315, entitled ROBOTIC ATTACHMENTCOMPRISING EXTERIOR DRIVE ACTUATOR; and

U.S. Design patent application Ser. No. 29/630,115, entitled SURGICALINSTRUMENT ASSEMBLY.

Applicant of the present application owns the following U.S. patentapplications that were filed on Dec. 15, 2017 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/843,485, entitled SEALED ADAPTERSFOR USE WITH ELECTROMECHANICAL SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/843,518, entitled END EFFECTORS WITHPOSITIVE JAW OPENING FEATURES FOR USE WITH ADAPTERS FORELECTROMECHANICAL SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/843,535, entitled SURGICAL ENDEFFECTORS WITH CLAMPING ASSEMBLIES CONFIGURED TO INCREASE JAW APERTURERANGES;

U.S. patent application Ser. No. 15/843,558, entitled SURGICAL ENDEFFECTORS WITH PIVOTAL JAWS CONFIGURED TO TOUCH AT THEIR RESPECTIVEDISTAL ENDS WHEN FULLY CLOSED;

U.S. patent application Ser. No. 15/843,528, entitled SURGICAL ENDEFFECTORS WITH JAW STIFFENER ARRANGEMENTS CONFIGURED TO PERMITMONITORING OF FIRING MEMBER;

U.S. patent application Ser. No. 15/843,567, entitled ADAPTERS WITH ENDEFFECTOR POSITION SENSING AND CONTROL ARRANGEMENTS FOR USE IN CONNECTIONWITH ELECTROMECHANICAL SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/843,556, entitled DYNAMIC CLAMPINGASSEMBLIES WITH IMPROVED WEAR CHARACTERISTICS FOR USE IN CONNECTION WITHELECTROMECHANICAL SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/843,514, entitled ADAPTERS WITHFIRING STROKE SENSING ARRANGEMENTS FOR USE IN CONNECTION WITHELECTROMECHANICAL SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/843,501, entitled ADAPTERS WITHCONTROL SYSTEMS FOR CONTROLLING MULTIPLE MOTORS OF AN ELECTROMECHANICALSURGICAL INSTRUMENT;

U.S. patent application Ser. No. 15/843,508, entitled HANDHELDELECTROMECHANICAL SURGICAL INSTRUMENTS WITH IMPROVED MOTOR CONTROLARRANGEMENTS FOR POSITIONING COMPONENTS OF AN ADAPTER COUPLED THERETO;

U.S. patent application Ser. No. 15/843,682, entitled SYSTEMS ANDMETHODS OF CONTROLLING A CLAMPING MEMBER FIRING RATE OF A SURGICALINSTRUMENT;

U.S. patent application Ser. No. 15/843,689, entitled SYSTEMS ANDMETHODS OF CONTROLLING A CLAMPING MEMBER; and

U.S. patent application Ser. No. 15/843,704, entitled METHODS OFOPERATING SURGICAL END EFFECTORS.

Applicant of the present application owns the following U.S. patentapplications that were filed on Jun. 29, 2017 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/636,829, entitled CLOSED LOOPVELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 15/636,837, entitled CLOSED LOOPVELOCITY CONTROL TECHNIQUES BASED ON SENSED TISSUE PARAMETERS FORROBOTIC SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 15/636,844, entitled CLOSED LOOPVELOCITY CONTROL OF CLOSURE MEMBER FOR ROBOTIC SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 15/636,854, entitled ROBOTIC SURGICALINSTRUMENT WITH CLOSED LOOP FEEDBACK TECHNIQUES FOR ADVANCEMENT OFCLOSURE MEMBER DURING FIRING; and

U.S. patent application Ser. No. 15/636,858, entitled SYSTEM FORCONTROLLING ARTICULATION FORCES.

Applicant of the present application owns the following U.S. patentapplications that were filed on Jun. 28, 2017 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/635,693, entitled SURGICALINSTRUMENT COMPRISING AN OFFSET ARTICULATION JOINT;

U.S. patent application Ser. No. 15/635,729, entitled SURGICALINSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO;

U.S. patent application Ser. No. 15/635,785, entitled SURGICALINSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO;

U.S. patent application Ser. No. 15/635,808, entitled SURGICALINSTRUMENT COMPRISING FIRING MEMBER SUPPORTS;

U.S. patent application Ser. No. 15/635,837, entitled SURGICALINSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE TO A FRAME;

U.S. patent application Ser. No. 15/635,941, entitled SURGICALINSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE BY A CLOSURESYSTEM;

U.S. patent application Ser. No. 15/636,029, entitled SURGICALINSTRUMENT COMPRISING A SHAFT INCLUDING A HOUSING ARRANGEMENT;

U.S. patent application Ser. No. 15/635,958, entitled SURGICALINSTRUMENT COMPRISING SELECTIVELY ACTUATABLE ROTATABLE COUPLERS;

U.S. patent application Ser. No. 15/635,981, entitled SURGICAL STAPLINGINSTRUMENTS COMPRISING SHORTENED STAPLE CARTRIDGE NOSES;

U.S. patent application Ser. No. 15/636,009, entitled SURGICALINSTRUMENT COMPRISING A SHAFT INCLUDING A CLOSURE TUBE PROFILE;

U.S. patent application Ser. No. 15/635,663, entitled METHOD FORARTICULATING A SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 15/635,530, entitled SURGICALINSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITH AXIALLY SHORTENEDARTICULATION JOINT CONFIGURATIONS;

U.S. patent application Ser. No. 15/635,549, entitled SURGICALINSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLY MOVABLE FIRINGMEMBER THAT IS INITIALLY PARKED IN CLOSE PROXIMITY TO THE JAWS PRIOR TOFIRING;

U.S. patent application Ser. No. 15/635,559, entitled SURGICALINSTRUMENTS WITH JAWS CONSTRAINED TO PIVOT ABOUT AN AXIS UPON CONTACTWITH A CLOSURE MEMBER THAT IS PARKED IN CLOSE PROXIMITY TO THE PIVOTAXIS;

U.S. patent application Ser. No. 15/635,578, entitled SURGICAL ENDEFFECTORS WITH IMPROVED JAW APERTURE ARRANGEMENTS;

U.S. patent application Ser. No. 15/635,594, entitled SURGICAL CUTTINGAND FASTENING DEVICES WITH PIVOTABLE ANVIL WITH A TISSUE LOCATINGARRANGEMENT IN CLOSE PROXIMITY TO AN ANVIL PIVOT;

U.S. patent application Ser. No. 15/635,612, entitled JAW RETAINERARRANGEMENT FOR RETAINING A PIVOTABLE SURGICAL INSTRUMENT JAW INPIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICAL INSTRUMENT JAW;

U.S. patent application Ser. No. 15/635,621, entitled SURGICALINSTRUMENT WITH POSITIVE JAW OPENING FEATURES;

U.S. patent application Ser. No. 15/635,631, entitled SURGICALINSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER;

U.S. patent application Ser. No. 15/635,521, entitled SURGICALINSTRUMENT LOCKOUT ARRANGEMENT;

U.S. Design patent application Ser. No. 29/609,087, entitled STAPLEFORMING ANVIL;

U.S. Design patent application Ser. No. 29/609,083, entitled SURGICALINSTRUMENT SHAFT; and

U.S. Design patent application Ser. No. 29/609,093, entitled SURGICALFASTENER CARTRIDGE.

Applicant of the present application owns the following U.S. patentapplications that were filed on Jun. 27, 2017 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/634,024, entitled SURGICAL ANVILMANUFACTURING METHODS;

U.S. patent application Ser. No. 15/634,035, entitled SURGICAL ANVILARRANGEMENTS;

U.S. patent application Ser. No. 15/634,046, entitled SURGICAL ANVILARRANGEMENTS;

U.S. patent application Ser. No. 15/634,054, entitled SURGICAL ANVILARRANGEMENTS;

U.S. patent application Ser. No. 15/634,068, entitled SURGICAL FIRINGMEMBER ARRANGEMENTS;

U.S. patent application Ser. No. 15/634,076, entitled STAPLE FORMINGPOCKET ARRANGEMENTS;

U.S. patent application Ser. No. 15/634,090, entitled STAPLE FORMINGPOCKET ARRANGEMENTS;

U.S. patent application Ser. No. 15/634,099, entitled SURGICAL ENDEFFECTORS AND ANVILS; and

U.S. patent application Ser. No. 15/634,117, entitled ARTICULATIONSYSTEMS FOR SURGICAL INSTRUMENTS.

Applicant of the present application owns the following U.S. patentapplications that were filed on Dec. 21, 2016 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/386,185, entitled SURGICAL STAPLINGINSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIES THEREOF;

U.S. patent application Ser. No. 15/386,230, entitled ARTICULATABLESURGICAL STAPLING INSTRUMENTS;

U.S. patent application Ser. No. 15/386,221, entitled LOCKOUTARRANGEMENTS FOR SURGICAL END EFFECTORS;

U.S. patent application Ser. No. 15/386,209, entitled SURGICAL ENDEFFECTORS AND FIRING MEMBERS THEREOF;

U.S. patent application Ser. No. 15/386,198, entitled LOCKOUTARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE TOOL ASSEMBLIES;

U.S. patent application Ser. No. 15/386,240, entitled SURGICAL ENDEFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR;

U.S. patent application Ser. No. 15/385,939, entitled STAPLE CARTRIDGESAND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN;

U.S. patent application Ser. No. 15/385,941, entitled SURGICAL TOOLASSEMBLIES WITH CLUTCHING ARRANGEMENTS FOR SHIFTING BETWEEN CLOSURESYSTEMS WITH CLOSURE STROKE REDUCTION FEATURES AND ARTICULATION ANDFIRING SYSTEMS;

U.S. patent application Ser. No. 15/385,943, entitled SURGICAL STAPLINGINSTRUMENTS AND STAPLE-FORMING ANVILS;

U.S. patent application Ser. No. 15/385,950, entitled SURGICAL TOOLASSEMBLIES WITH CLOSURE STROKE REDUCTION FEATURES;

U.S. patent application Ser. No. 15/385,945, entitled STAPLE CARTRIDGESAND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN;

U.S. patent application Ser. No. 15/385,946, entitled SURGICAL STAPLINGINSTRUMENTS AND STAPLE-FORMING ANVILS;

U.S. patent application Ser. No. 15/385,951, entitled SURGICALINSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASING A JAW OPENINGDISTANCE;

U.S. patent application Ser. No. 15/385,953, entitled METHODS OFSTAPLING TISSUE;

U.S. patent application Ser. No. 15/385,954, entitled FIRING MEMBERSWITH NON-PARALLEL JAW ENGAGEMENT FEATURES FOR SURGICAL END EFFECTORS;

U.S. patent application Ser. No. 15/385,955, entitled SURGICAL ENDEFFECTORS WITH EXPANDABLE TISSUE STOP ARRANGEMENTS;

U.S. patent application Ser. No. 15/385,948, entitled SURGICAL STAPLINGINSTRUMENTS AND STAPLE-FORMING ANVILS;

U.S. patent application Ser. No. 15/385,956, entitled SURGICALINSTRUMENTS WITH POSITIVE JAW OPENING FEATURES;

U.S. patent application Ser. No. 15/385,958, entitled SURGICALINSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTING FIRING SYSTEMACTUATION UNLESS AN UNSPENT STAPLE CARTRIDGE IS PRESENT;

U.S. patent application Ser. No. 15/385,947, entitled STAPLE CARTRIDGESAND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN;

U.S. patent application Ser. No. 15/385,896, entitled METHOD FORRESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT;

U.S. patent application Ser. No. 15/385,898, entitled STAPLE FORMINGPOCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF STAPLES;

U.S. patent application Ser. No. 15/385,899, entitled SURGICALINSTRUMENT COMPRISING IMPROVED JAW CONTROL;

U.S. patent application Ser. No. 15/385,901, entitled STAPLE CARTRIDGEAND STAPLE CARTRIDGE CHANNEL COMPRISING WINDOWS DEFINED THEREIN;

U.S. patent application Ser. No. 15/385,902, entitled SURGICALINSTRUMENT COMPRISING A CUTTING MEMBER;

U.S. patent application Ser. No. 15/385,904, entitled STAPLE FIRINGMEMBER COMPRISING A MISSING CARTRIDGE AND/OR SPENT CARTRIDGE LOCKOUT;

U.S. patent application Ser. No. 15/385,905, entitled FIRING ASSEMBLYCOMPRISING A LOCKOUT;

U.S. patent application Ser. No. 15/385,907, entitled SURGICALINSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUT AND A FIRINGASSEMBLY LOCKOUT;

U.S. patent application Ser. No. 15/385,908, entitled FIRING ASSEMBLYCOMPRISING A FUSE;

U.S. patent application Ser. No. 15/385,909, entitled FIRING ASSEMBLYCOMPRISING A MULTIPLE FAILED-STATE FUSE;

U.S. patent application Ser. No. 15/385,920, entitled STAPLE FORMINGPOCKET ARRANGEMENTS;

U.S. patent application Ser. No. 15/385,913, entitled ANVIL ARRANGEMENTSFOR SURGICAL STAPLE/FASTENERS;

U.S. patent application Ser. No. 15/385,914, entitled METHOD OFDEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGES WITH THESAME SURGICAL STAPLING INSTRUMENT;

U.S. patent application Ser. No. 15/385,893, entitled BILATERALLYASYMMETRIC STAPLE FORMING POCKET PAIRS;

U.S. patent application Ser. No. 15/385,929, entitled CLOSURE MEMBERSWITH CAM SURFACE ARRANGEMENTS FOR SURGICAL INSTRUMENTS WITH SEPARATE ANDDISTINCT CLOSURE AND FIRING SYSTEMS;

U.S. patent application Ser. No. 15/385,911, entitled SURGICALSTAPLE/FASTENERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND FIRINGSYSTEMS;

U.S. patent application Ser. No. 15/385,927, entitled SURGICAL STAPLINGINSTRUMENTS WITH SMART STAPLE CARTRIDGES;

U.S. patent application Ser. No. 15/385,917, entitled STAPLE CARTRIDGECOMPRISING STAPLES WITH DIFFERENT CLAMPING BREADTHS;

U.S. patent application Ser. No. 15/385,900, entitled STAPLE FORMINGPOCKET ARRANGEMENTS COMPRISING PRIMARY SIDEWALLS AND POCKET SIDEWALLS;

U.S. patent application Ser. No. 15/385,931, entitled NO-CARTRIDGE ANDSPENT CARTRIDGE LOCKOUT ARRANGEMENTS FOR SURGICAL STAPLE/FASTENERS;

U.S. patent application Ser. No. 15/385,915, entitled FIRING MEMBER PINANGLE;

U.S. patent application Ser. No. 15/385,897, entitled STAPLE FORMINGPOCKET ARRANGEMENTS COMPRISING ZONED FORMING SURFACE GROOVES;

U.S. patent application Ser. No. 15/385,922, entitled SURGICALINSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES;

U.S. patent application Ser. No. 15/385,924, entitled SURGICALINSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS;

U.S. patent application Ser. No. 15/385,912, entitled SURGICALINSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXIS AND INCLUDESEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS;

U.S. patent application Ser. No. 15/385,910, entitled ANVIL HAVING AKNIFE SLOT WIDTH;

U.S. patent application Ser. No. 15/385,906, entitled FIRING MEMBER PINCONFIGURATIONS;

U.S. patent application Ser. No. 15/386,188, entitled STEPPED STAPLECARTRIDGE WITH ASYMMETRICAL STAPLES;

U.S. patent application Ser. No. 15/386,192, entitled STEPPED STAPLECARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES;

U.S. patent application Ser. No. 15/386,206, entitled STAPLE CARTRIDGEWITH DEFORMABLE DRIVER RETENTION FEATURES;

U.S. patent application Ser. No. 15/386,226, entitled DURABILITYFEATURES FOR END EFFECTORS AND FIRING ASSEMBLIES OF SURGICAL STAPLINGINSTRUMENTS;

U.S. patent application Ser. No. 15/386,222, entitled SURGICAL STAPLINGINSTRUMENTS HAVING END EFFECTORS WITH POSITIVE OPENING FEATURES;

U.S. patent application Ser. No. 15/386,236, entitled CONNECTIONPORTIONS FOR DISPOSABLE LOADING UNITS FOR SURGICAL STAPLING INSTRUMENTS;

U.S. patent application Ser. No. 15/385,887, entitled METHOD FORATTACHING A SHAFT ASSEMBLY TO A SURGICAL INSTRUMENT AND, ALTERNATIVELY,TO A SURGICAL ROBOT;

U.S. patent application Ser. No. 15/385,889, entitled SHAFT ASSEMBLYCOMPRISING A MANUALLY-OPERABLE RETRACTION SYSTEM FOR USE WITH AMOTORIZED SURGICAL INSTRUMENT SYSTEM;

U.S. patent application Ser. No. 15/385,890, entitled SHAFT ASSEMBLYCOMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE SYSTEMS;

U.S. patent application Ser. No. 15/385,891, entitled SHAFT ASSEMBLYCOMPRISING A CLUTCH CONFIGURED TO ADAPT THE OUTPUT OF A ROTARY FIRINGMEMBER TO TWO DIFFERENT SYSTEMS;

U.S. patent application Ser. No. 15/385,892, entitled SURGICAL SYSTEMCOMPRISING A FIRING MEMBER ROTATABLE INTO AN ARTICULATION STATE TOARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM;

U.S. patent application Ser. No. 15/385,894, entitled SHAFT ASSEMBLYCOMPRISING A LOCKOUT;

U.S. patent application Ser. No. 15/385,895, entitled SHAFT ASSEMBLYCOMPRISING FIRST AND SECOND ARTICULATION LOCKOUTS;

U.S. patent application Ser. No. 15/385,916, entitled SURGICAL STAPLINGSYSTEMS;

U.S. patent application Ser. No. 15/385,918, entitled SURGICAL STAPLINGSYSTEMS;

U.S. patent application Ser. No. 15/385,919, entitled SURGICAL STAPLINGSYSTEMS;

U.S. patent application Ser. No. 15/385,921, entitled SURGICALSTAPLE/FASTENER CARTRIDGE WITH MOVABLE CAMMING MEMBER CONFIGURED TODISENGAGE FIRING MEMBER LOCKOUT FEATURES;

U.S. patent application Ser. No. 15/385,923, entitled SURGICAL STAPLINGSYSTEMS;

U.S. patent application Ser. No. 15/385,925, entitled JAW ACTUATED LOCKARRANGEMENTS FOR PREVENTING ADVANCEMENT OF A FIRING MEMBER IN A SURGICALEND EFFECTOR UNLESS AN UNFIRED CARTRIDGE IS INSTALLED IN THE ENDEFFECTOR;

U.S. patent application Ser. No. 15/385,926, entitled AXIALLY MOVABLECLOSURE SYSTEM ARRANGEMENTS FOR APPLYING CLOSURE MOTIONS TO JAWS OFSURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/385,928, entitled PROTECTIVE COVERARRANGEMENTS FOR A JOINT INTERFACE BETWEEN A MOVABLE JAW AND ACTUATORSHAFT OF A SURGICAL INSTRUMENT;

U.S. patent application Ser. No. 15/385,930, entitled SURGICAL ENDEFFECTOR WITH TWO SEPARATE COOPERATING OPENING FEATURES FOR OPENING ANDCLOSING END EFFECTOR JAWS;

U.S. patent application Ser. No. 15/385,932, entitled ARTICULATABLESURGICAL END EFFECTOR WITH ASYMMETRIC SHAFT ARRANGEMENT;

U.S. patent application Ser. No. 15/385,933, entitled ARTICULATABLESURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLE LINKAGE DISTAL OF ANARTICULATION LOCK;

U.S. patent application Ser. No. 15/385,934, entitled ARTICULATION LOCKARRANGEMENTS FOR LOCKING AN END EFFECTOR IN AN ARTICULATED POSITION INRESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM;

U.S. patent application Ser. No. 15/385,935, entitled LATERALLYACTUATABLE ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFECTOR OFA SURGICAL INSTRUMENT IN AN ARTICULATED CONFIGURATION; and

U.S. patent application Ser. No. 15/385,936, entitled ARTICULATABLESURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES.

Applicant of the present application owns the following U.S. patentapplications that were filed on Jun. 24, 2016 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 15/191,775, entitled STAPLE CARTRIDGECOMPRISING WIRE STAPLES AND STAMPED STAPLES;

U.S. patent application Ser. No. 15/191,807, entitled STAPLING SYSTEMFOR USE WITH WIRE STAPLES AND STAMPED STAPLES;

U.S. patent application Ser. No. 15/191,834, entitled STAMPED STAPLESAND STAPLE CARTRIDGES USING THE SAME;

U.S. patent application Ser. No. 15/191,788, entitled STAPLE CARTRIDGECOMPRISING OVERDRIVEN STAPLES; and

U.S. patent application Ser. No. 15/191,818, entitled STAPLE CARTRIDGECOMPRISING OFFSET LONGITUDINAL STAPLE ROWS.

Applicant of the present application owns the following U.S. patentapplications that were filed on Jun. 24, 2016 and which are each hereinincorporated by reference in their respective entireties:

U.S. Design patent application Ser. No. 29/569,218, entitled SURGICALFASTENER;

U.S. Design patent application Ser. No. 29/569,227, entitled SURGICALFASTENER;

U.S. Design patent application Ser. No. 29/569,259, entitled SURGICALFASTENER CARTRIDGE; and

U.S. Design patent application Ser. No. 29/569,264, entitled SURGICALFASTENER CARTRIDGE.

Applicant of the present application owns the following patentapplications that were filed on Apr. 1, 2016 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 15/089,325, entitled METHOD FOROPERATING A SURGICAL STAPLING SYSTEM, now U.S. Patent ApplicationPublication No. 2017/0281171;

U.S. patent application Ser. No. 15/089,321, entitled MODULAR SURGICALSTAPLING SYSTEM COMPRISING A DISPLAY, now U.S. Patent ApplicationPublication No. 2017/0281163;

U.S. patent application Ser. No. 15/089,326, entitled SURGICAL STAPLINGSYSTEM COMPRISING A DISPLAY INCLUDING A RE-ORIENTABLE DISPLAY FIELD, nowU.S. Patent Application Publication No. 2017/0281172;

U.S. patent application Ser. No. 15/089,263, entitled SURGICALINSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP PORTION, now U.S.Patent Application Publication No. 2017/0281165;

U.S. patent application Ser. No. 15/089,262, entitled ROTARY POWEREDSURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT SYSTEM, now U.S.Patent Application Publication No. 2017/0281161;

U.S. patent application Ser. No. 15/089,277, entitled SURGICAL CUTTINGAND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC DRIVE MEMBER, now U.S.Patent Application Publication No. 2017/0281166;

U.S. patent application Ser. No. 15/089,296, entitled INTERCHANGEABLESURGICAL TOOL ASSEMBLY WITH A SURGICAL END EFFECTOR THAT IS SELECTIVELYROTATABLE ABOUT A SHAFT AXIS, now U.S. Patent Application PublicationNo. 2017/0281168;

U.S. patent application Ser. No. 15/089,258, entitled SURGICAL STAPLINGSYSTEM COMPRISING A SHIFTABLE TRANSMISSION, now U.S. Patent ApplicationPublication No. 2017/0281178;

U.S. patent application Ser. No. 15/089,278, entitled SURGICAL STAPLINGSYSTEM CONFIGURED TO PROVIDE SELECTIVE CUTTING OF TISSUE, now U.S.Patent Application Publication No. 2017/0281162;

U.S. patent application Ser. No. 15/089,284, entitled SURGICAL STAPLINGSYSTEM COMPRISING A CONTOURABLE SHAFT, now U.S. Patent ApplicationPublication No. 2017/0281186;

U.S. patent application Ser. No. 15/089,295, entitled SURGICAL STAPLINGSYSTEM COMPRISING A TISSUE COMPRESSION LOCKOUT, now U.S. PatentApplication Publication No. 2017/0281187;

U.S. patent application Ser. No. 15/089,300, entitled SURGICAL STAPLINGSYSTEM COMPRISING AN UNCLAMPING LOCKOUT, now U.S. Patent ApplicationPublication No. 2017/0281179;

U.S. patent application Ser. No. 15/089,196, entitled SURGICAL STAPLINGSYSTEM COMPRISING A JAW CLOSURE LOCKOUT, now U.S. Patent ApplicationPublication No. 2017/0281183;

U.S. patent application Ser. No. 15/089,203, entitled SURGICAL STAPLINGSYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT, now U.S. Patent ApplicationPublication No. 2017/0281184;

U.S. patent application Ser. No. 15/089,210, entitled SURGICAL STAPLINGSYSTEM COMPRISING A SPENT CARTRIDGE LOCKOUT, now U.S. Patent ApplicationPublication No. 2017/0281185;

U.S. patent application Ser. No. 15/089,324, entitled SURGICALINSTRUMENT COMPRISING A SHIFTING MECHANISM, now U.S. Patent ApplicationPublication No. 2017/0281170;

U.S. patent application Ser. No. 15/089,335, entitled SURGICAL STAPLINGINSTRUMENT COMPRISING MULTIPLE LOCKOUTS, now U.S. Patent ApplicationPublication No. 2017/0281155;

U.S. patent application Ser. No. 15/089,339, entitled SURGICAL STAPLINGINSTRUMENT, now U.S. Patent Application Publication No. 2017/0281173;

U.S. patent application Ser. No. 15/089,253, entitled SURGICAL STAPLINGSYSTEM CONFIGURED TO APPLY ANNULAR ROWS OF STAPLES HAVING DIFFERENTHEIGHTS, now U.S. Patent Application Publication No. 2017/0281177;

U.S. patent application Ser. No. 15/089,304, entitled SURGICAL STAPLINGSYSTEM COMPRISING A GROOVED FORMING POCKET, now U.S. Patent ApplicationPublication No. 2017/0281188;

U.S. patent application Ser. No. 15/089,331, entitled ANVIL MODIFICATIONMEMBERS FOR SURGICAL STAPLE/FASTENERS, now U.S. Patent ApplicationPublication No. 2017/0281180;

U.S. patent application Ser. No. 15/089,336, entitled STAPLE CARTRIDGESWITH ATRAUMATIC FEATURES, now U.S. Patent Application Publication No.2017/0281164;

U.S. patent application Ser. No. 15/089,312, entitled CIRCULAR STAPLINGSYSTEM COMPRISING AN INCISABLE TISSUE SUPPORT, now U.S. PatentApplication Publication No. 2017/0281189;

U.S. patent application Ser. No. 15/089,309, entitled CIRCULAR STAPLINGSYSTEM COMPRISING ROTARY FIRING SYSTEM, now U.S. Patent ApplicationPublication No. 2017/0281169; and

U.S. patent application Ser. No. 15/089,349, entitled CIRCULAR STAPLINGSYSTEM COMPRISING LOAD CONTROL, now U.S. Patent Application PublicationNo. 2017/0281174.

Applicant of the present application also owns the U.S. patentapplications identified below which were filed on Dec. 30, 2015 whichare each herein incorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/984,488, entitled MECHANISMS FORCOMPENSATING FOR BATTERY PACK FAILURE IN POWERED SURGICAL INSTRUMENTS,now U.S. Patent Application Publication No. 2017/0189018;

U.S. patent application Ser. No. 14/984,525, entitled MECHANISMS FORCOMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS, nowU.S. Patent Application Publication No. 2017/0189019; and

U.S. patent application Ser. No. 14/984,552, entitled SURGICALINSTRUMENTS WITH SEPARABLE MOTORS AND MOTOR CONTROL CIRCUITS, now U.S.Patent Application Publication No. 2017/0189020.

Applicant of the present application also owns the U.S. patentapplications identified below which were filed on Feb. 9, 2016 which areeach herein incorporated by reference in their respective entirety:

U.S. patent application Ser. No. 15/019,220, entitled SURGICALINSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLATABLE END EFFECTOR, nowU.S. Patent Application Publication No. 2017/0224333;

U.S. patent application Ser. No. 15/019,228, entitled SURGICALINSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS, now U.S.Patent Application Publication No. 2017/0224342;

U.S. patent application Ser. No. 15/019,196, entitled SURGICALINSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT, nowU.S. Patent Application Publication No. 2017/0224330;

U.S. patent application Ser. No. 15/019,206, entitled SURGICALINSTRUMENTS WITH AN END EFFECTOR THAT IS HIGHLY ARTICULATABLE RELATIVETO AN ELONGATE SHAFT ASSEMBLY, now U.S. Patent Application PublicationNo. 2017/0224331;

U.S. patent application Ser. No. 15/019,215, entitled SURGICALINSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION ARRANGEMENTS, now U.S.Patent Application Publication No. 2017/0224332;

U.S. patent application Ser. No. 15/019,227, entitled ARTICULATABLESURGICAL INSTRUMENTS WITH SINGLE ARTICULATION LINK ARRANGEMENTS, nowU.S. Patent Application Publication No. 2017/0224334;

U.S. patent application Ser. No. 15/019,235, entitled SURGICALINSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEN ARTICULATIONSYSTEMS, now U.S. Patent Application Publication No. 2017/0224336;

U.S. patent application Ser. No. 15/019,230, entitled ARTICULATABLESURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAM ARRANGEMENTS, now U.S.Patent Application Publication No. 2017/0224335; and

U.S. patent application Ser. No. 15/019,245, entitled SURGICALINSTRUMENTS WITH CLOSURE STROKE REDUCTION ARRANGEMENTS, now U.S. PatentApplication Publication No. 2017/0224343.

Applicant of the present application also owns the U.S. patentapplications identified below which were filed on Feb. 12, 2016 whichare each herein incorporated by reference in their respective entirety:

U.S. patent application Ser. No. 15/043,254, entitled MECHANISMS FORCOMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/043,259, entitled MECHANISMS FORCOMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS;

U.S. patent application Ser. No. 15/043,275, entitled MECHANISMS FORCOMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; and

U.S. patent application Ser. No. 15/043,289, entitled MECHANISMS FORCOMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS.

Applicant of the present application owns the following patentapplications that were filed on Jun. 18, 2015 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/742,925, entitled SURGICAL ENDEFFECTORS WITH POSITIVE JAW OPENING ARRANGEMENTS, now U.S. PatentApplication Publication No. 2016/0367256;

U.S. patent application Ser. No. 14/742,941, entitled SURGICAL ENDEFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES, now U.S. PatentApplication Publication No. 2016/0367248;

U.S. patent application Ser. No. 14/742,914, entitled MOVABLE FIRINGBEAM SUPPORT ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS, nowU.S. Patent Application Publication No. 2016/0367255;

U.S. patent application Ser. No. 14/742,900, entitled ARTICULATABLESURGICAL INSTRUMENTS WITH COMPOSITE FIRING BEAM STRUCTURES WITH CENTERFIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT, now U.S. PatentApplication Publication No. 2016/0367254;

U.S. patent application Ser. No. 14/742,885, entitled DUAL ARTICULATIONDRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS, nowU.S. Patent Application Publication No. 2016/0367246; and

U.S. patent application Ser. No. 14/742,876, entitled PUSH/PULLARTICULATION DRIVE SYSTEMS FOR ARTICULATABLE SURGICAL INSTRUMENTS, nowU.S. Patent Application Publication No. 2016/0367245.

Applicant of the present application owns the following patentapplications that were filed on Mar. 6, 2015 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/640,746, entitled POWERED SURGICALINSTRUMENT, now U.S. Pat. No. 9,808,246;

U.S. patent application Ser. No. 14/640,795, entitled MULTIPLE LEVELTHRESHOLDS TO MODIFY OPERATION OF POWERED SURGICAL INSTRUMENTS, now U.S.Patent Application Publication No. 2016/02561185;

U.S. patent application Ser. No. 14/640,832, entitled ADAPTIVE TISSUECOMPRESSION TECHNIQUES TO ADJUST CLOSURE RATES FOR MULTIPLE TISSUETYPES, now U.S. Patent Application Publication No. 2016/0256154;

U.S. patent application Ser. No. 14/640,935, entitled OVERLAID MULTISENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUECOMPRESSION, now U.S. Patent Application Publication No. 2016/0256071;

U.S. patent application Ser. No. 14/640,831, entitled MONITORING SPEEDCONTROL AND PRECISION INCREMENTING OF MOTOR FOR POWERED SURGICALINSTRUMENTS, now U.S. Patent Application Publication No. 2016/0256153;

U.S. patent application Ser. No. 14/640,859, entitled TIME DEPENDENTEVALUATION OF SENSOR DATA TO DETERMINE STABILITY, CREEP, ANDVISCOELASTIC ELEMENTS OF MEASURES, now U.S. Patent ApplicationPublication No. 2016/0256187;

U.S. patent application Ser. No. 14/640,817, entitled INTERACTIVEFEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS, now U.S. PatentApplication Publication No. 2016/0256186;

U.S. patent application Ser. No. 14/640,844, entitled CONTROL TECHNIQUESAND SUB-PROCESSOR CONTAINED WITHIN MODULAR SHAFT WITH SELECT CONTROLPROCESSING FROM HANDLE, now U.S. Patent Application Publication No.2016/0256155;

U.S. patent application Ser. No. 14/640,837, entitled SMART SENSORS WITHLOCAL SIGNAL PROCESSING, now U.S. Patent Application Publication No.2016/0256163;

U.S. patent application Ser. No. 14/640,765, entitled SYSTEM FORDETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A SURGICALSTAPLE/FASTENER, now U.S. Patent Application Publication No.2016/0256160;

U.S. patent application Ser. No. 14/640,799, entitled SIGNAL AND POWERCOMMUNICATION SYSTEM POSITIONED ON A ROTATABLE SHAFT, now U.S. PatentApplication Publication No. 2016/0256162; and

U.S. patent application Ser. No. 14/640,780, entitled SURGICALINSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING, now U.S. PatentApplication Publication No. 2016/0256161.

Applicant of the present application owns the following patentapplications that were filed on Feb. 27, 2015, and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/633,576, entitled SURGICALINSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION, now U.S. PatentApplication Publication No. 2016/0249919;

U.S. patent application Ser. No. 14/633,546, entitled SURGICAL APPARATUSCONFIGURED TO ASSESS WHETHER A PERFORMANCE PARAMETER OF THE SURGICALAPPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND, now U.S. PatentApplication Publication No. 2016/0249915;

U.S. patent application Ser. No. 14/633,560, entitled SURGICAL CHARGINGSYSTEM THAT CHARGES AND/OR CONDITIONS ONE OR MORE BATTERIES, now U.S.Patent Application Publication No. 2016/0249910;

U.S. patent application Ser. No. 14/633,566, entitled CHARGING SYSTEMTHAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A BATTERY, now U.S.Patent Application Publication No. 2016/0249918;

U.S. patent application Ser. No. 14/633,555, entitled SYSTEM FORMONITORING WHETHER A SURGICAL INSTRUMENT NEEDS TO BE SERVICED, now U.S.Patent Application Publication No. 2016/0249916;

U.S. patent application Ser. No. 14/633,542, entitled REINFORCED BATTERYFOR A SURGICAL INSTRUMENT, now U.S. Patent Application Publication No.2016/0249908;

U.S. patent application Ser. No. 14/633,548, entitled POWER ADAPTER FORA SURGICAL INSTRUMENT, now U.S. Patent Application Publication No.2016/0249909;

U.S. patent application Ser. No. 14/633,526, entitled ADAPTABLE SURGICALINSTRUMENT HANDLE, now U.S. Patent Application Publication No.2016/0249945;

U.S. patent application Ser. No. 14/633,541, entitled MODULAR STAPLINGASSEMBLY, now U.S. Patent Application Publication No. 2016/0249927; and

U.S. patent application Ser. No. 14/633,562, entitled SURGICAL APPARATUSCONFIGURED TO TRACK AN END-OF-LIFE PARAMETER, now U.S. PatentApplication Publication No. 2016/0249917.

Applicant of the present application owns the following patentapplications that were filed on Dec. 18, 2014 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/574,478, entitled SURGICALINSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END EFFECTOR AND MEANSFOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER, now U.S. Pat. No.9,844,374;

U.S. patent application Ser. No. 14/574,483, entitled SURGICALINSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS, now U.S. PatentApplication Publication No. 2016/0174969;

U.S. patent application Ser. No. 14/575,139, entitled DRIVE ARRANGEMENTSFOR ARTICULATABLE SURGICAL INSTRUMENTS, now U.S. Pat. No. 9,844,375;

U.S. patent application Ser. No. 14/575,148, entitled LOCKINGARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITH ARTICULATABLE SURGICALEND EFFECTORS, now U.S. Patent Application Publication No. 2016/0174976;

U.S. patent application Ser. No. 14/575,130, entitled SURGICALINSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLE ABOUT A DISCRETENON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE, now U.S. PatentApplication Publication No. 2016/0174972;

U.S. patent application Ser. No. 14/575,143, entitled SURGICALINSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS, now U.S. PatentApplication Publication No. 2016/0174983;

U.S. patent application Ser. No. 14/575,117, entitled SURGICALINSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAMSUPPORT ARRANGEMENTS, now U.S. Patent Application Publication No.2016/0174975;

U.S. patent application Ser. No. 14/575,154, entitled SURGICALINSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAMSUPPORT ARRANGEMENTS, now U.S. Patent Application Publication No.2016/0174973;

U.S. patent application Ser. No. 14/574,493, entitled SURGICALINSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM, now U.S.Patent Application Publication No. 2016/0174970; and

U.S. patent application Ser. No. 14/574,500, entitled SURGICALINSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM, now U.S.Patent Application Publication No. 2016/0174971.

Applicant of the present application owns the following patentapplications that were filed on Mar. 1, 2013 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 13/782,295, entitled ARTICULATABLESURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION,now U.S. Pat. No. 9,700,309;

U.S. patent application Ser. No. 13/782,323, entitled ROTARY POWEREDARTICULATION JOINTS FOR SURGICAL INSTRUMENTS, now U.S. Pat. No.9,782,169;

U.S. patent application Ser. No. 13/782,338, entitled THUMBWHEEL SWITCHARRANGEMENTS FOR SURGICAL INSTRUMENTS, now U.S. Patent ApplicationPublication No. 2014/0249557;

U.S. patent application Ser. No. 13/782,499, entitled ELECTROMECHANICALSURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT, now U.S. Pat. No.9,358,003;

U.S. patent application Ser. No. 13/782,460, entitled MULTIPLE PROCESSORMOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS, now U.S. Pat. No.9,554,794;

U.S. patent application Ser. No. 13/782,358, entitled JOYSTICK SWITCHASSEMBLIES FOR SURGICAL INSTRUMENTS, now U.S. Pat. No. 9,326,767;

U.S. patent application Ser. No. 13/782,481, entitled SENSORSTRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR, now U.S. Pat.No. 9,468,438;

U.S. patent application Ser. No. 13/782,518, entitled CONTROL METHODSFOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMENT PORTIONS, now U.S.Patent Application Publication No. 2014/0246475;

U.S. patent application Ser. No. 13/782,375, entitled ROTARY POWEREDSURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM, now U.S. Pat. No.9,398,911; and

U.S. patent application Ser. No. 13/782,536, entitled SURGICALINSTRUMENT SOFT STOP, now U.S. Pat. No. 9,307,986.

Applicant of the present application also owns the following patentapplications that were filed on Mar. 14, 2013 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 13/803,097, entitled ARTICULATABLESURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, now U.S. Pat. No.9,687,230;

U.S. patent application Ser. No. 13/803,193, entitled CONTROLARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT, now U.S. Pat.No. 9,332,987;

U.S. patent application Ser. No. 13/803,053, entitled INTERCHANGEABLESHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT, now U.S. PatentApplication Publication No. 2014/0263564;

U.S. patent application Ser. No. 13/803,086, entitled ARTICULATABLESURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, now U.S. PatentApplication Publication No. 2014/0263541;

U.S. patent application Ser. No. 13/803,210, entitled SENSORARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS,now U.S. Pat. No. 9,808,244;

U.S. patent application Ser. No. 13/803,148, entitled MULTI-FUNCTIONMOTOR FOR A SURGICAL INSTRUMENT, now U.S. Patent Application PublicationNo. 2014/0263554;

U.S. patent application Ser. No. 13/803,066, entitled DRIVE SYSTEMLOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, now U.S. Pat. No.9,629,623;

U.S. patent application Ser. No. 13/803,117, entitled ARTICULATIONCONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS, now U.S. Pat. No.9,351,726;

U.S. patent application Ser. No. 13/803,130, entitled DRIVE TRAINCONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, now U.S. Pat. No.9,351,727; and

U.S. patent application Ser. No. 13/803,159, entitled METHOD AND SYSTEMFOR OPERATING A SURGICAL INSTRUMENT, now U.S. Patent ApplicationPublication No. 2014/0277017.

Applicant of the present application also owns the following patentapplication that was filed on Mar. 7, 2014 and is herein incorporated byreference in its entirety:

U.S. patent application Ser. No. 14/200,111, entitled CONTROL SYSTEMSFOR SURGICAL INSTRUMENTS, now U.S. Pat. No. 9,629,629.

Applicant of the present application also owns the following patentapplications that were filed on Mar. 26, 2014 and are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/226,106, entitled POWER MANAGEMENTCONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, now U.S. Patent ApplicationPublication No. 2015/0272582;

U.S. patent application Ser. No. 14/226,099, entitled STERILIZATIONVERIFICATION CIRCUIT, now U.S. Pat. No. 9,826,977;

U.S. patent application Ser. No. 14/226,094, entitled VERIFICATION OFNUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT, now U.S. Patent ApplicationPublication No. 2015/0272580;

U.S. patent application Ser. No. 14/226,117, entitled POWER MANAGEMENTTHROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL, now U.S.Patent Application Publication No. 2015/0272574;

U.S. patent application Ser. No. 14/226,075, entitled MODULAR POWEREDSURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES, now U.S. Pat. No.9,743,929;

U.S. patent application Ser. No. 14/226,093, entitled FEEDBACKALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS, now U.S.Patent Application Publication No. 2015/0272569;

U.S. patent application Ser. No. 14/226,116, entitled SURGICALINSTRUMENT UTILIZING SENSOR ADAPTATION, now U.S. Patent ApplicationPublication No. 2015/0272571;

U.S. patent application Ser. No. 14/226,071, entitled SURGICALINSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR, now U.S. Pat. No.9,690,362;

U.S. patent application Ser. No. 14/226,097, entitled SURGICALINSTRUMENT COMPRISING INTERACTIVE SYSTEMS, now U.S. Pat. No. 9,820,738;

U.S. patent application Ser. No. 14/226,126, entitled INTERFACE SYSTEMSFOR USE WITH SURGICAL INSTRUMENTS, now U.S. Patent ApplicationPublication No. 2015/0272572;

U.S. patent application Ser. No. 14/226,133, entitled MODULAR SURGICALINSTRUMENT SYSTEM, now U.S. Patent Application Publication No.2015/0272557;

U.S. patent application Ser. No. 14/226,081, entitled SYSTEMS ANDMETHODS FOR CONTROLLING A SEGMENTED CIRCUIT, now U.S. Pat. No.9,804,618;

U.S. patent application Ser. No. 14/226,076, entitled POWER MANAGEMENTTHROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION, now U.S. Pat.No. 9,733,663;

U.S. patent application Ser. No. 14/226,111, entitled SURGICAL STAPLINGINSTRUMENT SYSTEM, now U.S. Pat. No. 9,750,499; and

U.S. patent application Ser. No. 14/226,125, entitled SURGICALINSTRUMENT COMPRISING A ROTATABLE SHAFT, now U.S. Patent ApplicationPublication No. 2015/0280384.

Applicant of the present application also owns the following patentapplications that were filed on Sep. 5, 2014 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/479,103, entitled CIRCUITRY ANDSENSORS FOR POWERED MEDICAL DEVICE, now U.S. Patent ApplicationPublication No. 2016/0066912;

U.S. patent application Ser. No. 14/479,119, entitled ADJUNCT WITHINTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION, now U.S. Pat. No.9,724,094;

U.S. patent application Ser. No. 14/478,908, entitled MONITORING DEVICEDEGRADATION BASED ON COMPONENT EVALUATION, now U.S. Pat. No. 9,737,301;

U.S. patent application Ser. No. 14/478,895, entitled MULTIPLE SENSORSWITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR INTERPRETATION,now U.S. Pat. No. 9,757,128;

U.S. patent application Ser. No. 14/479,110, entitled POLARITY OF HALLMAGNET TO DETECT MISLOADED CARTRIDGE, now U.S. Patent ApplicationPublication No. 2016/0066915;

U.S. patent application Ser. No. 14/479,098, entitled SMART CARTRIDGEWAKE UP OPERATION AND DATA RETENTION, now U.S. Patent ApplicationPublication No. 2016/0066911;

U.S. patent application Ser. No. 14/479,115, entitled MULTIPLE MOTORCONTROL FOR POWERED MEDICAL DEVICE, now U.S. Pat. No. 9,788,836; and

U.S. patent application Ser. No. 14/479,108, entitled LOCAL DISPLAY OFTISSUE PARAMETER STABILIZATION, now U.S. Patent Application PublicationNo. 2016/0066913.

Applicant of the present application also owns the following patentapplications that were filed on Apr. 9, 2014 and which are each hereinincorporated by reference in their respective entirety:

U.S. patent application Ser. No. 14/248,590, entitled MOTOR DRIVENSURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS, now U.S. Pat. No.9,826,976;

U.S. patent application Ser. No. 14/248,581, entitled SURGICALINSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRING DRIVE OPERATED FROMTHE SAME ROTATABLE OUTPUT, now U.S. Pat. No. 9,649,110;

U.S. patent application Ser. No. 14/248,595, entitled SURGICALINSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THESURGICAL INSTRUMENT, now U.S. Pat. No. 9,844,368;

U.S. patent application Ser. No. 14/248,588, entitled POWERED LINEARSURGICAL STAPLE/FASTENER, now U.S. Patent Application Publication No.2014/0309666;

U.S. patent application Ser. No. 14/248,591, entitled TRANSMISSIONARRANGEMENT FOR A SURGICAL INSTRUMENT, now U.S. Patent ApplicationPublication No. 2014/0305991;

U.S. patent application Ser. No. 14/248,584, entitled MODULAR MOTORDRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARYDRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS, now U.S. Pat. No.9,801,626;

U.S. patent application Ser. No. 14/248,587, entitled POWERED SURGICALSTAPLE/FASTENER, now U.S. Patent Application Publication No.2014/0309665;

U.S. patent application Ser. No. 14/248,586, entitled DRIVE SYSTEMDECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT, now U.S. PatentApplication Publication No. 2014/0305990; and

U.S. patent application Ser. No. 14/248,607, entitled MODULAR MOTORDRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS, nowU.S. Pat. No. 9,814,460.

Applicant of the present application also owns the following patentapplications that were filed on Apr. 16, 2013 and which are each hereinincorporated by reference in their respective entirety:

U.S. Provisional Patent Application Ser. No. 61/812,365, entitledSURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR;

U.S. Provisional Patent Application Ser. No. 61/812,376, entitled LINEARCUTTER WITH POWER;

U.S. Provisional Patent Application Ser. No. 61/812,382, entitled LINEARCUTTER WITH MOTOR AND PISTOL GRIP;

U.S. Provisional Patent Application Ser. No. 61/812,385, entitledSURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS AND MOTORCONTROL; and

U.S. Provisional Patent Application Ser. No. 61/812,372, entitledSURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR.

Numerous specific details are set forth to provide a thoroughunderstanding of the overall structure, function, manufacture, and useof the embodiments as described in the specification and illustrated inthe accompanying drawings. Well-known operations, components, andelements have not been described in detail so as not to obscure theembodiments described in the specification. The reader will understandthat the embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”), and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a surgicalsystem, device, or apparatus that “comprises,” “has,” “includes”, or“contains” one or more elements possesses those one or more elements,but is not limited to possessing only those one or more elements.Likewise, an element of a system, device, or apparatus that “comprises,”“has,” “includes”, or “contains” one or more features possesses thoseone or more features, but is not limited to possessing only those one ormore features.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performinglaparoscopic and minimally invasive surgical procedures. However, thereader will readily appreciate that the various methods and devicesdisclosed herein can be used in numerous surgical procedures andapplications including, for example, in connection with open surgicalprocedures. As the present Detailed Description proceeds, the readerwill further appreciate that the various instruments disclosed hereincan be inserted into a body in any way, such as through a naturalorifice, through an incision or puncture hole formed in tissue, etc. Theworking portions or end effector portions of the instruments can beinserted directly into a patient's body or can be inserted through anaccess device that has a working channel through which the end effectorand elongate shaft of a surgical instrument can be advanced.

Various surgical instruments are disclosed herein which are configuredto fasten the tissue of a patient. As discussed in greater detail below,such surgical instruments comprise an end effector and a plurality ofdrive systems configured to perform various end effector functions. Suchdrive systems can include an anvil drive system configured to clamp thetissue within the end effector, a staple firing system configured todeploy staples into the tissue, and/or a tissue cutting systemconfigured to cut the tissue, for example. Such drive systems can alsoinclude an articulation drive system configured to articulate the endeffector, a tissue drive system configured to move the end effectorrelative to the tissue, and/or a staple loading system configured toreload the end effector with staples, for example. As also discussed ingreater detail below, two or more of these drive systems can be operablycoupled to a common drive system such that they are operatedsynchronously.

A stapling instrument 1000 is illustrated in FIG. 1. The staplinginstrument 1000 comprises a handle 1100, a shaft assembly 1200 extendingfrom the handle 1100, and an end effector 1300 extending from the shaftassembly 1200. The handle 1100 comprises a frame 1110 and grippingportions 1120 positioned on opposite sides of the frame 1110. The handle1100 further comprises a plurality of electric motors configured tooperate the drive systems of the stapling instrument 1000. Threeelectric motors 1130, 1140, and 1150 are depicted, but the surgicalinstrument 1000 can include any suitable number of electric motors. Eachelectric motor is operably coupled with a rotatable output. Forinstance, the electric motor 1130 is operably coupled to a rotatableoutput 1135, the electric motor 1140 is operably coupled to a rotatableoutput 1145, and the electric motor 1150 is operably coupled to arotatable output 1155. The handle 1100 further comprises batteries 1160,for example, which supply power to the electric motors 1130, 1140, and1150. Referring to FIG. 11, the batteries 1160 comprise lithium 18650batteries, for example, but can comprise any suitable battery. Referringprimarily to FIG. 12, the batteries 1160 are positioned in a batterycompartment 1115 defined in the handle frame 1110, but can be stored inany suitable location. The batteries 1160 are also configured to supplypower to a control system and/or display of the handle 1110, which aredescribed in greater detail below.

A handle 1100′ is illustrated in FIGS. 8 and 10. The handle 1100′ issimilar to the handle 1100 in many respects, most of which will not bediscussed herein for the sake of brevity. The handle 1100′ comprises abattery compartment which is accessible through a door 1115′. The door1115′ permits the batteries in the battery compartment to be replaced. Ahandle 1100″ is illustrated in FIG. 9. The handle 1100″ is similar tothe handle 1100 in many respects, most of which will not be discussedherein for the sake of brevity. The handle 1100″ comprises a plug 1115″configured to supply power to the handle 1100″ from a generator and/orwall outlet, for example. In various instances, the handle 1100″ can bepowered from an internal source, such as by the batteries 1160, forexample, and an external source, such as by the plug 1115″, for example.

Referring again to FIG. 1, the handle frame 1110 comprises a connector1170. The shaft assembly 1200 comprises an outer housing 1210 whichincludes a shaft connector 1270 configured to be engaged with the handleconnector 1170 to couple the shaft assembly 1200 to the handle 1100. Theshaft connector 1270 and the handle 1170 comprise a rotatable bayonetinterconnection; however, any suitable interconnection could be used.The shaft assembly 1200 further comprises a rotatable input 1235configured to be operably coupled with the rotatable output 1135 whenthe shaft assembly 1200 is assembled to the handle 1100. Similarly, theshaft assembly 1200 also comprises a rotatable input 1245 configured tobe operably coupled with the rotatable output 1145 and a rotatable input1255 configured to be operably coupled with the rotatable output 1155when the shaft assembly 1200 is assembled to the handle 1100.

Further to the above, the outer shaft housing 1210 further comprises adistal connector 1290. The end effector 1300 comprises a shaft portion1310 which includes an end effector connector 1390 configured to beengaged with the distal connector 1290 to couple the end effector 1300to the shaft assembly 1200. The end effector connector 1390 and thedistal shaft connector 1290 comprise a rotatable interconnection;however, any suitable interconnection could be used. The end effector1300 further comprises a first drive configured to be operably coupledto the shaft input 1235 when the end effector 1300 is assembled to theshaft assembly 1200. Similarly, the end effector 1300 comprises a seconddrive configured to be operably coupled to the shaft input 1245 and athird drive configured to be operably coupled to the shaft input 1255when the end effector 1300 is assembled to the shaft assembly 1200.

In various instances, the shaft assembly 1200 and/or the end effector1300 comprises one more sensors and/or electrically-driven components.Referring to FIG. 2, the stapling instrument 1000 comprises at least oneelectrical circuit extending through the handle 1100, the shaft assembly1200, and the end effector 1300. The electrical circuit comprisesconductors in the handle 1100, the shaft assembly 1200, and the endeffector 1300 which are placed in electrical communication with oneanother when the shaft assembly 1200 is assembled to the handle 1100 andthe end effector 1300 is assembled to the shaft assembly 1200. FIG. 2illustrates four conductors 1280 in the shaft assembly 1200 which arepart of two separate electrical circuits; however, any suitable numberof conductors and/or circuits can be used. The handle connector 1170 andthe shaft connector 1270 comprise electrical contacts which are rotatedinto engagement when the shaft assembly 1200 is rotatably assembled tothe handle 1100. Similarly, the distal shaft connector 1290 and the endeffector connector 1390 comprise electrical contacts which are rotatedinto engagement when the end effector 1300 is assembled to the shaftassembly 1200.

Referring again to FIG. 1, the end effector 1300 further comprises adistal head 1320 rotatably connected to the shaft portion 1310 about anarticulation joint 1370. The end effector 1300 also comprises anarticulation drive system configured to articulate the distal head 1320relative to the shaft portion 1310. The distal head 1320 comprises ananvil 1360 which is movable between an open position and a closedposition. In use, the anvil 1360 is movable toward a tissue compressionsurface 1325 by an anvil drive system in order to clamp, or compress,tissue within the end effector 1300. As will be discussed in connectionwith FIGS. 3-7 below, the tissue compression surface 1325 is defined ona tissue drive system which is configured to engage the patient tissueand move the stapling instrument 1000 relative to the patient tissue.

Referring primarily to FIG. 3, the end effector 1300 comprises arotatable drive shaft 1330 which is usable to selectively open the anvil1360, operate the tissue drive system (FIGS. 4-6) to re-position thedistal head 1320 relative to the patient tissue, and close the anvil1360 (FIG. 7) before the stapling instrument 1000 performs a staplefiring stroke. The drive shaft 1330 is driven by an electric motor and,moreover, the drive shaft 1330 is translatable between a first positionin which a key 1332 extending from the drive shaft 1330 is operablyengaged with the tissue drive system (FIGS. 4-6) and a second positionin which the key 1332 is operably engaged with the anvil drive system(FIG. 7). When the drive shaft 1330 is in its first position, the key1332 is positioned within a key slot 1333 defined in a drive gear 1331of the tissue drive system. When the drive shaft 1330 is in its secondposition, the key 1332 is positioned within a key slot 1363 defined in adrive collar 1361 of the anvil drive system.

Referring to FIGS. 4-6, the tissue drive system comprises a first foot1380 a and a second foot 1380 b. The feet 1380 a, 1380 b are extendableto engage the patient tissue and then retractable to pull the distalhead 1320 of the end effector 1300 relative to the patient tissue. Thetissue drive system is configured to extend the first foot 1380 a whileretracting the second foot 1380 b and, similarly, extend the second foot1380 b while retracting the first foot 1380 a. FIG. 4 illustrates thefirst foot 1380 a in an extended position and the second foot 1380 b ina retracted position. As a result of the above, the tissue drive systemcan be configured to walk the end effector 1300 across the tissue tocreate a staple firing path within the tissue. In various alternativeembodiments, the tissue drive system can be configured to extend thefirst foot 1380 a and second foot 1380 b simultaneously and/or retractthe first foot 1380 a and second foot 1380 b simultaneously.

Further to the above, the tissue drive system comprises a first geartrain configured to transfer the rotation of the drive shaft 1330 to thefirst gear 1380 a and a second gear train configured to transfer therotation of the drive shaft 1330 to the second gear 1380 b. The firstgear train comprises a spur gear 1381 a operably intermeshed with thedrive gear 1331, a transfer gear 1382 a operably intermeshed with thespur gear 1381 a, and a spur gear 1383 a operably intermeshed with thetransfer gear 1382 a such that the rotation of the shaft 1330 istransferred to the spur gear 1383 a. The first gear train furthercomprises a shaft gear 1384 a operably intermeshed with the spur gear1383 a. Referring primarily to FIGS. 5 and 6, the shaft gear 1384 a isfixedly mounted to a transfer shaft 1385 a such that the rotation of thespur gear 1383 a is transferred to the transfer shaft 1385 a. The firstgear train further comprises a bevel gear 1386 a fixedly mounted to thetransfer shaft 1385 a, a side bevel gear 1387 a operably intermeshedwith the bevel gear 1386 a, and a pinion gear 1388 a fixedly mounted tothe side bevel gear 1387 a such that the pinion gear 1388 a rotates withthe side bevel gear 1387 a. Referring primarily to FIG. 6, the piniongear 1388 a is operably intermeshed with a rack 1389 a mounted to thefirst foot 1380 a which converts the rotational input motion totranslational motion of the first foot 1380 a.

The second gear train is similar to the first gear train in manyrespects except that the second gear train does not include a transfergear intermediate the two spur gears, as discussed below. The secondgear train comprises a spur gear 1381 b operably intermeshed with thedrive gear 1331 and a spur gear 1383 b operably intermeshed with thespur gear 1381 b such that the rotation of the shaft 1330 is transferredto the spur gear 1383 b. The second gear train further comprises a shaftgear 1384 b operably intermeshed with the spur gear 1383 b. Referringprimarily to FIG. 5, the shaft gear 1384 b is fixedly mounted to atransfer shaft 1385 b such that the rotation of the spur gear 1383 b istransferred to the transfer shaft 1385 b. The second gear train furthercomprises a bevel gear 1386 b fixedly mounted to the transfer shaft 1385b, a side bevel gear 1387 b operably intermeshed with the bevel gear1386 b, and a pinion gear 1388 b fixedly mounted to the side bevel gear1387 b such that the pinion gear 1388 b rotates with the side bevel gear1387 b. The pinion gear 1388 b is operably intermeshed with a rack 1389b mounted to the second foot 1380 b which converts the rotational inputmotion to translational motion of the second foot 1380 b.

The presence of a transfer gear 1382 a in the first gear train and theabsence of a corresponding transfer gear in the second gear train causethe first foot 1380 a and the second foot 1380 b to move in oppositedirections in response to the rotation of the drive shaft 1330. Forinstance, the first foot 1380 a is extended and the second foot 1380 bis retracted when the drive shaft 1330 is rotated in a first direction.Correspondingly, the first foot 1380 a is retracted and the second foot1380 b is extended when the drive shaft 1330 is rotated in a second, oropposite, direction. As discussed above, the first and second feet 1380a, 1380 b are configured to grasp and pull the end effector 1300relative to the tissue as they are extended and retracted. While themotion of the feet 1380 a, 1380 b may be linear, other embodiments aredisclosed herein which provide different motions, such as an arcuatemotion, for example.

Once the end effector 1300 has been suitably moved relative to thetissue by the tissue drive system, the drive shaft 1330 is translatedlongitudinally out of engagement with the tissue drive system and intoengagement with the anvil drive system, as illustrated in FIG. 7. Invarious instances, the rotation of the drive shaft 1330 can be stoppedbefore it is disengaged from the tissue drive system. In otherinstances, the drive shaft 1330 can continue to rotate as it isdisengaged from the tissue drive system and translated into engagementwith the drive collar 1361. In either event, the drive collar 1361comprises a threaded aperture 1362 defined therein including threads1365. The anvil 1360 comprises a push rod 1364 extending therefrom whichincludes an end threadably engaged with the threads 1365 in the aperture1366. When the drive collar 1361 is rotated in a first direction by thedrive shaft 1330, the drive collar 1361 pushes the anvil 1360 away fromthe feet 1380 a and 1380 b to open the anvil 1360. Once the anvil 1360has been sufficiently opened, the drive shaft 1330 can be shifted toengage the tissue drive system and move the end effector 1300 relativeto the tissue. The drive shaft 1330 can then be re-engaged with theanvil drive system. When the drive collar 1361 is rotated in a second,or opposite, direction, at such point, the drive collar 1361 pulls theanvil 1360 toward the feet 1380 a and 1380 b to close or clamp the anvil1360, as illustrated in FIG. 7. Once the anvil 1360 has been closed, thestaple firing system of the stapling instrument 1000 can be actuated. Atsuch point, the anvil 1360 is re-opened by the anvil drive system andthe above-described cycle can be repeated.

Notably, the drive shaft 1330 extends along a longitudinal axis 1339which is collinear with a longitudinal axis 1369 extending through thepush rod 1364 of the anvil drive system. Such an arrangement allows thedrive shaft 1330 to be operably linked to the push rod 1334 through thedrive collar 1361. Also, notably, the drive collar 1361 comprises aproximal flange 1367 and a distal flange 1368 extending therefrom. Theflanges 1367 and 1368 act as stops which limit the longitudinal travelof the anvil 1360 in the proximal and distal directions, respectively.As such, the flanges 1367 and 1368 define the limits of the opening andclosing strokes of the anvil 1360. The anvil 1360 comprises a tissueclamping face which extends orthogonally, or at least substantiallyorthogonally, to the longitudinal axis 1369 and moves longitudinallyrelative to the distal head 1320. The anvil 1360 comprises a movable jawand the feet 1380 a and 1380 b of the tissue drive system compriseanother movable jaw positioned opposite the anvil 1360.

Referring again to FIG. 3, a longitudinal gap is present between thedrive gear 1331 of the tissue drive system and the drive collar 1361 ofthe anvil drive system. As a result, a dwell in operation may be presentwhen shifting between the tissue drive system and the anvil drivesystem. A shorter gap can result in shorter dwells while a longer gapcan result in longer dwells. Other embodiments are envisioned in whichno, or very little, gap is present between the drive gear 1331 and thedrive collar 1361 and, as a result, the operational dwell can beeliminated.

Referring again to FIG. 1, the end effector 1300 comprises a pluralityof staple cartridges 1400 stored therein. The stapling instrument 1000comprises a cartridge drive system configured to push a staple cartridge1400 into the end effector 1300. As a result, the cartridge drive systemcan be used to reload the end effector 1300 without having to remove thestapling instrument 1000 from the surgical site. Once the supply ofstaple cartridges 1400 in the end effector 1300 have been depleted,however, the stapling instrument 1000 may have to be removed from thesurgical site to be reloaded unless the stapling instrument 1000comprises a system for loading cartridges during the operation of thestapling instrument 1000. Such a system is described in greater detailbelow. In any event, the end effector 1300 can be detached from theshaft assembly 1200 and an unspent end effector 1300 can then beattached to the shaft assembly 1200 to reload the stapling instrument1000.

Referring again to FIG. 1, each end effector 1300 is intended for asmany uses as there are staples or staple cartridges stored in the endeffector 1300. The shaft assembly 1200 is intended for more uses than anend effector 1300. As a result, a spent end effector 1300 can bereplaced with another end effector 1300 without having to replace theshaft assembly 1200. In at least one instance, each end effector 1300 isintended for 10 uses while the shaft assembly is intended for 100 uses,for example. The handle 1100 is intended for more uses than the shaftassembly 1200 and/or an end effector 1300. As a result, a used shaftassembly 1200 can be replaced without having to replace the handle 1100.In at least one instance, the shaft assembly 1200 is intended for 100uses while the handle 1100 is intended for 500 uses, for example.

As discussed above, the stapling instrument 1000 comprises a drivesystem configured to reciprocatingly open, or unclamp, an anvil, createrelative motion between the end effector and the patient tissue, andthen clamp the anvil once again. FIGS. 42 and 43 illustrate an exemplaryembodiment of another reciprocating drive system that could be used. Thedrive system 2800 comprises a rotatable drive shaft 2830 and a drivegear 2831 fixedly mounted to the drive shaft 2830. The drive system 2800further comprises a spur gear 2832 operably intermeshed with the drivegear 2831 such that the rotation of the drive shaft 2830 is transmittedto the spur gear 2832. The drive system 2800 further comprises a bevelgear 2833 that is mounted to and rotates with the spur gear 2832, a sidebevel gear 2834 operably intermeshed with the bevel gear 2833, and aspur gear 2835 operably intermeshed with a gear mounted to a face of thebevel gear 2834. The drive system 2800 further comprises a pinion gear2836 that is fixedly mounted to and rotates with the spur gear 2835, anoutput gear 2837 operably intermeshed with the pinion gear 2836, and acam 2838 that is fixedly mounted to and rotates with the output gear2837. As a result of the above, the rotation of the drive shaft 2830rotates the cam 2838 which, as described below, is converted toreciprocating motion of the drive shaft 2830.

Further to the above, the drive system 2800 comprises a rotatableshifter 2840 including a cam arm 2848 and a shifter arm 2849 which isrotatable about a pivot 2841. In use, the cam 2838 is configured toengage the cam arm 2848 of the shifter 2840 and rotate the shifter 2840between a first position (FIG. 43) and a second position (FIG. 42). Whenthe shifter 2840 is rotated into its second position, as illustrated inFIG. 42, the cam arm 2848 engages a shoulder 2839 defined on the driveshaft 2830 and pushes the drive shaft 2830 upwardly. A spring 2820 ispositioned between the shoulder 2839 and a frame 2819 of the staplinginstrument which is compressed when the drive shaft 2830 is moved intoits second position and stores potential energy therein. As the cam 2838continues to rotate, the cam 2838 disengages from the cam arm 2848 andthe spring 2820 resiliently returns the drive shaft 2830 back into itsfirst position, illustrated in FIG. 43. This reciprocating movement ofthe drive shaft 2830 between its first and second positions can be usedto operate a reciprocating drive system in the end effector of thestapling instrument.

FIG. 44 illustrates another exemplary embodiment of a reciprocatingdrive system. The drive system 2900 comprises an electric motor 2930, afirst drive system 2940 operably coupled with the electric motor 2930,and a second drive system 2950 operably coupled with the electric motor2930. The electric motor 2930 comprises a rotatable output shaft 2931and a drive gear 2932 fixedly mounted to the output shaft 2931. Thefirst drive system 2940 comprises an input gear 2942 operablyintermeshed with the drive gear 2932. The input gear 2942 is fixedlymounted to a drive shaft 2943 such that the drive shaft 2943 rotateswith the input gear 2942. The first drive system 2940 further comprisesa barrel cam 2944 that is slidably mounted to the drive shaft 2943 androtates with the drive shaft 2943. The barrel cam 2944 comprises anaperture 2945 defined therein that comprises a non-circular profile, forexample, that is configured to transfer rotation between the drive shaft2943 and the barrel cam 2944, yet permit relative translationtherebetween. The barrel cam 2944 further comprises a cam slot 2949defined therearound which interacts with a cam pin 2919 mounted to aframe 2910 such that, when the barrel cam 2944 is rotated, the barrelcam 2944 is also translated. The barrel cam 2944 is translated distallywhen the barrel cam 2944 is rotated in a first direction and translatedproximally when the barrel cam 2944 is rotated in a second, or opposite,direction. The first drive system 2940 further comprises a drive shaft2946 extending from the barrel cam 2944 that is configured to drive afirst end effector function.

The second drive system 2950 comprises an input gear 2952 operablyintermeshed with the drive gear 2932. The input gear 2952 is fixedlymounted to a drive shaft 2953 such that the drive shaft 2953 rotateswith the input gear 2952. The second drive system 2950 further comprisesa barrel cam 2954 that is slidably mounted to the drive shaft 2953 androtates with the drive shaft 2953. The barrel cam 2954 comprises anaperture 2955 defined therein that comprises a non-circular profile, forexample, that is configured to transfer rotation between the drive shaft2953 and the barrel cam 2954, yet permit relative translationtherebetween. The barrel cam 2954 further comprises a cam slot 2959defined therearound which interacts with a cam pin 2919 mounted to theframe 2910 such that, when the barrel cam 2954 is rotated, the barrelcam 2944 is also translated. The barrel cam 2954 is translated distallywhen the barrel cam 2954 is rotated in a first direction and translatedproximally when the barrel cam 2954 is rotated in a second, or opposite,direction. The second drive system 2950 further comprises a drive shaft2956 extending from the barrel cam 2954 that is configured to drive asecond end effector function.

When the electric motor 2930 of the drive system 2900 is rotated in afirst direction, the first drive shaft 2946 is advanced distally and thesecond drive shaft 2956 is retracted proximally. Correspondingly, thefirst drive shaft 2946 is retracted proximally and the second driveshaft 2956 is advanced distally when the electric motor 2930 is operatedin a second, or opposite, direction. Other embodiments are envisioned inwhich the drive shafts 2946 and 2956 are advanced distally at the sametime.

Referring to FIGS. 92 and 93, a stapling instrument 4500 comprises atissue drive 4590 including a first foot 4580 a and a second foot 4580b. The first foot 4580 a comprises a rack of teeth 4583 a definedthereon, the second foot 4580 b comprises a rack of teeth 4583 b definedthereon, and the tissue drive 4500 further comprises a pinion gear 4593meshingly engaged with the racks 4583 a and 4583 b. The pinion gear 4593is rotatable back and forth about an axis to reciprocatingly extend andretract the feet 4580 a and 4580 b and, as a result, drive the staplinginstrument relative to the tissue of a patient. The tissue drive 4590further comprises a first actuator 4592 pinned to the pinion gear 4593at a pivot joint 4591 and a second actuator 4594 pinned to the piniongear 4593 at a pivot joint 4595. In use, the first actuator 4592 ispushed and/or the second actuator 4594 is pulled to rotate the piniongear 4593 in a first direction, extend the second foot 4580 b, andretract the first foot 4580 a. Correspondingly, the first actuator 4592is pulled and/or the second actuator 4594 is pushed to rotate the piniongear 4593 in a second direction, extend the first foot 4580 a, andretract the second foot 4580 b. Notably, the feet 4580 a and 4580 b aredisplaced linearly and in opposite directions. That said, the feet 4580a and 4580 b are configured such that, when one of the feet 4580 a and4580 b is being retracted to pull the tissue, the other foot slides, orslips, relative to the tissue as it is extended.

As discussed above, the feet 1380 a and 1380 b of the staplinginstrument 1000 are extended and retracted along linear paths. In suchinstances, the feet 1380 a and 1380 b may slide over the tissue as theyare being extended and then grab and pull the tissue as they are beingretracted. The feet 1380 a and 1380 b can comprise teeth extendingtherefrom which have profiles which facilitate the feet 1380 a and 1380b to slide relative to the tissue when moved in one direction and grabthe tissue when moved in the opposite direction. In at least oneinstance, the teeth are substantially triangular, for example, butcomprise a shallow angle on a first side and a steeper angle on theother side. In such instances, the shallow angle permits the first sideto slide relative to the tissue, whereas the steeper angle on the secondside bites or grabs the tissue when the feet 1380 a and 1380 b areretracted.

As discussed above, the feet 1380 a and 1380 b are driven along a linearpath by the racks 1389 a and 1389 b defined thereon. In some instances,the linear motion of the feet 1380 a and 1380 b can be tightly guidedwith little, if any, float or deviation from the linear motion. Invarious embodiments, referring now to FIGS. 88 and 89, the feet of atissue drive system can comprise one or more joints which provide atleast one additional degree of freedom which allows the feet to deviatefrom a purely linear path. The tissue drive system 4200 comprises afirst foot 4280 a and a second foot 4280 b which are movably connectedby a link 4282. The link 4282 is coupled to the first foot 4280 a at apivot joint 4281 a and the second foot 4280 b at a pivot joint 4281 b.The feet 4280 a and 4280 b are moved proximally and distally by an input4290 which includes a drive shaft 4292 connected to the link 4282 at apivot joint 4283. The pivot joints 4281 a, 4281 b, and 4283 allow thefeet 4280 a and 4280 b to lift or float upwardly when extended acrossthe tissue.

As discussed above, the stapling instruments disclosed herein comprisinga tissue drive system are configured to drive, or march, themselvesacross the tissue of a patient as they staple and cut the patient tissuealong a staple firing path. In various instances, the thickness of thetissue can change along the length of the staple firing path. Statedanother way, the tissue can increase and/or decrease in thickness in aforward-to-back direction and/or a lateral side-to-side direction.Referring again to FIGS. 88 and 89, the degrees of freedom provided bythe pivot joints 4281 a, 4281 b, and 4283 allow the feet 4280 a and 4280b to tilt in response to these changes in tissue thickness. Forinstance, the feet 4280 a and 4280 b can tilt in a forward-to-backdirection and/or in a side-to-side direction. Moreover, the feet 4280 aand 4280 b can tilt independently of one another. As such, the feet 4280a and 4280 b can tilt in the same direction or in different directions.That said, alternative embodiments are envisioned in which the feet 4280a and 4280 b tilt in the same direction. Such an arrangement could havea simpler drive system. In any event, the feet 4280 a and 4280 b canself-level in response to changes in tissue thickness and can have adesired traction on the tissue.

Referring now to FIG. 87, a stapling instrument 4100 comprises a distalstapling head 4120 which, similar to the stapling instrument 1000,comprises a tissue drive system 4190 including feet 4180. The tissuedrive system 4190 comprises a rocker link 4192 rotatably mounted withinthe stapling head 4120 about a pivot pin 4124. The rocker link 4192comprises legs 4193 and the pivot pin 4124 extends through apertures4194 defined in the legs 4193. Each of the legs 4193 is pivotablyconnected to a foot 4180 about a pivot pin 4195. In use, the tissuedrive system 4190 rocks the rocker link 4192 back and forth to extendand retract the feet 4180 along a non-linear, or curved, path. The feet4180 are extended and retracted together, although embodiments areenvisioned in which they are moved in opposite directions. Moreover,further to the above, the feet 4180 can tilt about the pivot pints 4195in order to adapt to changes in tissue thickness. In various instances,the tissue drive system 4190 can lift the feet 4180 away from the tissuefor at least part of the tissue drive stroke, such as at the end of thetissue drive stroke, for example.

Referring now to FIGS. 37-41, a surgical instrument 2700 comprises adistal head 2720 including an anvil 2760, a tissue drive foot 2780, anda tissue drive 2790. The tissue drive 2790 comprises a positioning rod2791 attached to the drive foot 2780 at a pivot joint 2781. Thepositioning rod 2791 is displaceable along a longitudinal axis to engage(FIG. 38) and disengage (FIG. 41) the drive foot 2780 from the patienttissue T. When the drive foot 2780 is disengaged from the tissue andwithdrawn into the distal head 2720, referring to FIG. 37, a distal tip2785 of the drive foot 2780 is positioned within, and does not extendfrom, the distal head 2720. Moreover, the drive foot 2780 is locked inposition, or prevented from being rotated, when the drive foot 2780 iswithdrawn into the distal head 2720. More specifically, the distal head2720 comprises a control slot 2724 defined therein and the foot 2780comprises two control pins 2784 slidably positioned in the control slot2724 which are configured to prevent the drive foot 2780 from rotatingwhen the drive foot 2780 is in its withdrawn position (FIGS. 37 and 41)and to permit the drive foot 2780 to rotate when the drive foot 2780 isin its engaged position (FIGS. 38-40), which is discussed below.

Referring to FIGS. 38-40, the drive foot 2780 is configured to engagethe patient tissue T and drive the distal head 2720 relative to thetissue in order to re-position the distal head 2720 relative to thetissue. The tissue drive 2790 comprises a first driver 2792 and a seconddriver 2793 configured to rotate the foot 2780 about the pivot joint2781. The first driver 2792 comprises a push end positioned within afirst socket 2782 defined in the drive foot 2780 and the second driver2793 comprises a push end positioned within a second socket 2783 definedon the opposite side of the drive foot 2780. Referring to FIG. 40, thefirst driver 2792 is displaceable toward the tissue to rotate the drivefoot 2780 in a first direction. Referring to FIG. 39, the second driver2793 is displaceable toward the tissue to rotate the drive foot in asecond, or opposite, direction. In use, the drive foot 2780 is rotatableback and forth by the tissue drive 2790 to create relative motionbetween the distal head 2720 and the tissue in the forward or backwarddirections.

Referring now to FIGS. 78-85, a stapling instrument 3900 comprises adistal head 3920 which includes, a staple firing system 3950 configuredto staple the tissue of a patient, an anvil 3960 configured to clamp thepatient tissue against a tissue compression surface 3925 and deform thestaples deployed by the staple firing system 3950, and feet 3980configured to generate relative movement between the distal head 3920and the tissue when the anvil 3960 is in an unclamped position. Thestapling instrument 3900 further comprises a tissue drive 3990configured to extend and retract the feet 3980. Referring primarily toFIGS. 83 and 84, the tissue drive 3990 comprises a rotatable drive shaft3992 and a worm gear 3993 fixedly mounted to the drive shaft 3992 suchthat the worm gear 3993 rotates with the drive shaft 3992. The worm gear3993 is meshingly engaged with a gear face 3995 defined on one side of adrive wheel 3994. The drive wheel 3994 is rotatably mounted about a pin3991 which is mounted to the distal head 3920. As a result of the above,the drive wheel 3994 rotates in response to the rotation of the driveshaft 3992.

Further to the above, referring to FIGS. 79-82, the tissue drive 3990further comprises a coupler bar 3996 comprising a first end slidablypositioned in a cam slot 3999 (FIGS. 83 and 85) defined in a secondside, or face, of the drive wheel 3994. In at least one instance, thecoupler bar 3996 comprises a pin that rides in the cam slot 3999. Thecoupler bar 3996 further comprises a second end pivotably mounted to thefeet 3980 at pivot joints 3998. When the drive wheel 3994 is rotated,the sidewalls of the cam slot 3999 push the first end of the coupler bar3996 through a path, or motion, indicated in FIG. 84. This path is alsoillustrated in FIGS. 79A, 80A, 81A, and 82A which track the motion ofthe tissue drive 3990 and the feet 3980 depicted in FIGS. 79, 80, 81,and 82, respectively. FIG. 79 illustrates the feet 3980 in a retractedposition and FIG. 79A shows a dot P on the foot motion path FM thatrepresents the position of the feet 3980 along the foot motion path FM.FIG. 80 illustrates the feet 3980 being extended and FIG. 80A shows thedot P advanced along the foot motion path FM. FIG. 81 illustrates thefeet 3980 in a fully-extended position and the dot P advanced furtheralong the foot motion path FM. FIG. 82 illustrates the feet 3980returned to their retracted position. At such point, the motion of thefeet 3980 can be repeated, or reciprocated.

Further to the above, the coupler bar 3996 comprises a longitudinal slot3997 defined therein and the staple head 3920 comprises a pin 3927extending into the longitudinal slot 3997 which co-operate to limit orconstrain the motion of the coupler bar 3996. FIGS. 84 and 85 map threecorresponding positions, labeled 1, 2, and 3, along the cam slot 3999and the firing motion path FM. The position 1 corresponds to the point Pin FIG. 79A, the position 2 corresponds to the point P in FIG. 80A, andthe position 3 corresponds to point P in FIG. 81A. In various instances,the tissue drive 3990 comprises a four-bar linkage in which the feet3980 are lofted when then they are extended. In order to facilitate thismotion, each foot 3980 comprises a slot 3981 defined therein, thesidewalls of which slide relative to a pin 3921 extending into the slot3981. The pin 3921/slot 3981 arrangements permit the feet 3980 totranslate and rotate during the tissue drive stroke cycle.

FIG. 86 illustrates an alternative embodiment of a cam path 4099 whichcomprises shoulders which prevent back motion of the coupler bar 3996within the slot 3999. For instance, the cam path 4099 comprises a firstshoulder 4091 which corresponds to the position 1 and FIG. 79A and, oncethe coupler bar 3996 has passed this point, the coupler bar 3996 cannotbacktrack past the position 1. The cam path 4099 comprises a secondshoulder 4092 which corresponds to the position 2 and FIG. 80A and, oncethe coupler bar 3996 has passed this point, the coupler bar 3996 cannotbacktrack past the position 2. The cam 4099 also comprises a thirdshoulder 4093 which corresponds to the position 3 and FIG. 81A and, oncethe coupler bar 3996 has passed this point, the coupler bar 3996 cannotbacktrack past the position 3.

Referring to FIGS. 50-56, a stapling instrument 3100 comprises a distalhead 3120 including an anvil 3160 and tissue drive feet 3180. Referringto FIG. 50, the drive feet 3180 are extendable to engage the tissue of apatient and then, referring to FIG. 51, retractable to move the distalhead 3120 relative to the patient tissue. Each drive foot 3180 comprisesa rack, or an array, of teeth 3193 configured to engage the patienttissue which is also movable between extended and retracted positions.FIG. 51 illustrates that the teeth 3193 extend from the drive feet 3180when the drive feet 3180 are being retracted from an extended position.More specifically, the teeth 3193 protrude from tissue compressionsurfaces 3125 defined on the drive feet 3180 when the drive feet 3180are being retracted from their fully-extended position. On the otherhand, referring to FIG. 50, the teeth 3193 do not protrude from thetissue compression surfaces 3125 as the drive feet 3180 are beingextended which allows the drive feet 3180 to slide relative to thepatient tissue while being extended.

Referring to FIGS. 52-56, the stapling instrument 3100 comprises atissue drive 3190 configured to extend and retract the drive feet 3180and, also, extend and retract the teeth 3193. The tissue drive 3190comprises an input bar 3191 that extends into, and is movable within, acavity 3181 defined in each drive foot 3180. The input bar 3191 movesthe drive feet 3180 through a circuitous, non-linear path which includesa raised, retracted position (FIGS. 52 and 56), a lowered, retractedposition (FIG. 53), a lowered, extended position (FIG. 54), and araised, extended position (FIG. 55). The input bar 3191 comprises pins3192 extending therefrom which extend into slots 3182 defined in thedrive feet 3180. As discussed in greater detail below, the interactionbetween the pins 3192 and the sidewalls of the slots 3182 transfers themotion of the input bar 3191 to the drive feet 3180. Each of the slots3182 extend along an axis which is transverse to and non-parallel to alongitudinal axis of the distal head 3120 which, as a result, createsthe desired motion of the drive feet 3180 and teeth 3193.

When the input bar 3191 is in a fully-retracted position, as illustratedin FIG. 52, the input bar 3191 positions the drive feet 3180 in theirraised, retracted position. In this position, the teeth 3193 protrudethrough windows 3183 defined in the drive feet 3180. As the input bar3191 is moved out of its fully-retracted position, referring to FIG. 53,the pins 3192 interact with the sidewalls of the slots 3182 and cam thedrive feet 3180 downwardly. At such point, the teeth 3193 no longerprotrude through the windows 3183. As the input bar 3191 is movedfurther away from its fully-retracted position, the input bar 3191begins to extend the drive feet 3180 as illustrated in FIG. 54. Notably,the teeth 3193 do not protrude through the windows 3183 as the drivefeet 3180 are being extended. However, once the input bar 3191 isretracted, as illustrated in FIG. 55, the pins 3192 interact with thesidewalls of the slots 3182 to raise the drive feet 3180 which causesthe teeth 3193 to protrude through the windows 3183. As a result, theteeth 3193 can engage or grab the patient tissue and pull the tissuerelative to the distal head 3120 until the drive feet 3180 are fullyretracted, as illustrated in FIG. 56. At such point, the tissue can bestapled and/or incised. The above-described process can be repeated tomove the stapling instrument 3100 along an entire staple firing path.

Referring to FIGS. 57-59D, a stapling instrument 3200 comprises a distalstapling head 3220 including tissue drive feet 3270 which are extendedoutwardly and retracted inwardly along the same path by a tissue drivesystem, such as the tissue drive system of the stapling instrument 1000,for example. That said, the stapling head 3220 further comprises lateraldrive feet 3280 which move with the drive feet 3270 but can also movelaterally relative to the drive feet 3270, as illustrated in FIGS. 57and 58. As a result, the lateral drive feet 3280 can be extended alongone path, as illustrated in FIGS. 59A and 59B, extended laterally, andthen retracted along a different path, as illustrated in FIGS. 59C and59D. Moreover, the drive feet 3270 and 3280 can pull the distal head3220 relative to the patient tissue in two different directions, whichprovides greater control over the relative movement between the distalstapling head 3220 and the patient tissue.

Referring primarily to FIGS. 57 and 58, the drive feet 3270 and 3280 arerotatably coupled in pairs. Each pair comprises an actuator plate 3260,a first link 3272 pivotably coupled to the drive foot 3270 about a pivot3271, and a second link 3282 pivotably coupled to the lateral drive foot3280 about a pivot 3281. When a downward force is applied to theactuator plate 3260, referring to FIG. 58, the actuator plate 3260pushes on a joint 3213 rotatably connecting the first link 3272 and thesecond link 3282, which causes the lateral foot 3280 to displaceoutwardly. Moreover, the distal head 3220 constrains the lateralmovement of the drive foot 3270 and, as a result, the drive foot 3270does not move laterally when the lateral drive foot 3280 is extendedlaterally. However, referring to FIGS. 60A-60D, alternative embodimentsare envisioned in which the drive foot 3270 can also move laterally. Ineither event, a biasing member, such as a torsion spring positioned inand/or coupled to the joint 3213, for example, can retract the drivefeet laterally after the pushing force is removed from the actuatorplate 3260. FIGS. 59A-59D depict a sequence of steps that can berepeated by the surgical instrument 3200 to move the stapling instrument3200 along a staple firing path. FIGS. 60A-60D also depict a sequence ofsteps that can be repeated by the surgical instrument 3200 to move thestapling instrument 3200 along a staple firing path.

Referring to FIGS. 61 and 62, a surgical instrument 3300 comprises adistal head 3320 and laterally-extendable drive feet 3380. The drivefeet 3380 are coupled to distal head 3320 via flexible connectors 3375and actuators 3370. When a compressive force is applied to an actuator3370, the actuator 3370 is displaced and/or compressed which causes theconnectors 3375 to extend laterally and push the corresponding drivefoot 3380 laterally. When the compressive force is removed from theactuator 3370, the connectors 3375 resiliently contract and pull thedrive foot 3380 inwardly. The drive feet 3380 can include tissuegripping features defined thereon which are configured to push and/orpull the patient tissue when the drive feet 3380 are being movedlaterally. As a result, the drive feet 3380 can create relative movementbetween the distal head 3320 and the patient tissue.

Referring to FIGS. 91A-91D, a stapling instrument 4400 comprises adistal head 4420 which includes a tissue cutting drive 4440, a staplefiring drive 4450, and a tissue drive including feet 4480. Each foot4480 is rotatably mounted to the distal head 4420 about a pivot pin 4481and is rotatable to drive the distal head 4420 relative to the patienttissue. FIG. 91 illustrates the feet 4480 in a retracted position. FIG.91B illustrates the feet 4480 being extended. FIG. 91C illustrates thefeet 4480 in their fully-extended position. FIG. 91D illustrates thefeet 4480 being retracted. When the feet 4480 are extended, the feet4480 drive the distal head 4420 relative to the patient tissue. Notably,the feet 4480 are synchronized such that they are extended and retractedtogether and, in such instances, the feet 4480 can drive the distal head4420 along a straight, or at least substantially straight, line. Thatsaid, one of the feet 4480 can be extended while the other foot 4480 isretracted. In such instances, the feet 4480 can turn the distal head4420 along a curved path.

Referring to FIGS. 76 and 77A-77D, a stapling instrument 3800 comprisesa distal head 3820 including a staple firing system 3850, an anvil 3860,and a tissue drive system. The tissue drive system comprises a firstfoot 3880 a and a second foot 3880 b and is configured to selectivelyextend and retract the feet 3880 a and 3880 b to move the staplinginstrument 3800 along a staple firing path FP. The tissue drive systemis configured to move, or march, the stapling instrument 3800 alongstraight and/or curved staple firing paths. Referring to FIGS. 77A and77B, the tissue drive system is configured to simultaneously extend andretract the first foot 3880 a and the second foot 3880 b an equal, or anat least nearly equal, amount to move the distal firing head 3220 alonga straight firing path. Referring to FIGS. 77C and 77D, the tissue drivesystem is also configured to extend and retract only one of the feet3880 a and 3880 b to turn the distal firing head 3220. For instance,referring to FIG. 77C, the tissue drive system can extend and retractthe first foot 3880 a, while not extending and retracting the secondfoot 3880 b, to turn the distal head 3820 in a first direction.Similarly, referring to FIG. 77D, the tissue drive system can extend andretract the second foot 3880 b, while not extending and retracting thefirst foot 3880 a, to turn the distal head 3820 in a second direction.

As discussed above, the tissue drive system is configured to turn thedistal head 3820 of the stapling instrument 3800 by operating one of thefeet 3880 a and 3880 b, but not the other. Alternatively, the tissuedrive system can be configured to turn the distal head 3820 by extendingone of the feet 3880 a and 3880 b less than the other. The distal head3820 could be gradually turned in such instances. The tissue drivesystem can also be configured to turn the distal head 3820 by moving thefeet 3880 a and 3880 b in opposite directions. In such instances, thedistal head 3820 could follow small, or tight, radiuses of curvature inthe staple firing path FP.

Referring to FIGS. 63 and 64, a stapling instrument 3400 comprises adistal head 3420 including a staple firing system 3450, an anvil 3460,and a tissue drive system. The tissue drive system comprises two drivewheels 3480 and a shaft 3481, which is rotatably supported by mounts3482, extending through apertures defined in the center of the drivewheels 3480. The drive wheels 3480 are fixedly mounted to the pin 3481such that the drive wheels 3480 rotate together. Each drive wheel 3480comprises an array of teeth extending therearound and at least one ofthe drive wheels 3480 is meshingly engaged with a drive shaft of anelectric motor. The teeth extending around the drive wheels 3480 arealso suitably configured to engage and grip the patient tissue. In use,the electric motor can be operated to turn the drive wheels 3480 tocreate relative movement between the distal head 3420 and the patienttissue and move the distal head 3420 along a staple firing path.

Referring to FIG. 94, a stapling instrument 4600 comprises a distal head4620 including a staple firing system 4650, an anvil 4660, and a tissuedrive system. The tissue drive system comprises drive two drive wheels4680 which are each rotatably supported by a separate pin extendingthrough the center thereof. As a result, the drive wheels 4680 can berotated independently. Each drive wheel 4680 comprises an array of teethextending therearound which is meshingly engaged with a drive shaft ofan electric motor. Stated another way, the tissue drive system comprisestwo electric motors which are configured to rotate the drive wheels 4680separately. Similar to the above, the teeth extending around the drivewheels 4680 are also suitably configured to engage and grip the patienttissue. In use, the electric motors can be operated to turn the drivewheels 4680 to create relative movement between the distal head 4620 andthe patient tissue and move the distal head 4620 along a staple firingpath, as described in greater detail below.

Further to the above, the tissue drive system is configured to rotatethe drive wheels 4680 in the same direction at the same speed to movethe distal head 4620 along a straight staple firing path. The tissuedrive system is also configured to rotate the wheels 4680 in the samedirection, but at different speeds, to turn the distal head 4620 along acurved staple firing path. The distal head 4620 can make gradual turnsin such instances. The tissue drive system is also configured to turnonly one of the drive wheels 4680, while not turning the other drivewheel 4680, to turn the distal head 4620 along a curved staple firingpath. Moreover, the tissue drive system is further configured to rotatethe drive wheels 4680 in opposite directions to turn the distal head4620 along curved staple firing paths having a small, or tight, radiusof curvature.

The tissue drive system further comprises lateral drive wheels 4670which are positioned laterally with respect to the drive wheels 4680.Similar to the above, each lateral drive wheel 4670 is operably coupledto a different electric motor. As a result, the tissue drive system ofthe stapling instrument 4600 comprises four electric motors which areoperable at the same time or at different times. The lateral drivewheels 4670 are operable independently of the drive wheels 4680,although they could be operated at the same time as one or both of thedrive wheels 4680. Moreover, the lateral drive wheels 4670 are operableindependently with respect to each other. Similar to the drive wheels4680, the tissue drive system is configured to turn the lateral drivewheels 4670 together at the same speed, at different speeds, and/or indifferent directions to move the distal head 4620 along a staple firingpath. Moreover, the tissue drive system is configured to turn anysuitable combination of the drive wheels 4670 and 4680 in any suitabledirection and at any suitable speed to move the stapling instrument 4600along a desired staple firing path.

Referring to FIG. 36, a stapling instrument 2600 comprises a distal head2620 including a staple firing system 2650, an anvil 2660, and a tissuedrive system. The tissue drive system comprises two drive wheels 2670and two drive wheels 2680 which can be rotated independently, at thesame time or at different times, to move the distal head 2620 along astaple firing path. Each drive wheel 2670 is rotatable about an axis2671 and each drive wheel 2680 is rotatable about an axis 2681; however,the axes 2671 are not parallel to the axes 2681. In fact, the axes 2671and 2681 are orthogonal, but can be oriented in any suitable direction.The tissue drive system comprises four electric motors which areconfigured to rotate the drive wheels 2670 and 2680 separately; however,the tissue drive system can have any suitable number of electric motorsto drive the drive wheels 2670 and 2680. In use, the electric motors canbe operated to turn the drive wheels 2670 and 2680 to create relativemovement between the distal head 2620 and the patient tissue and movethe distal head 2620 along a staple firing path.

Referring now to FIGS. 75A-75D, a stapling instrument 3700 comprises adistal head 3720 including an anvil 3760 and a tissue drive systemincluding a tissue drive foot 3780. The stapling instrument 3700 issimilar to the stapling instrument 1000 in many respects, most of whichwill not be discussed herein for the sake of brevity. The anvil 3760 ismovable relative to the foot 3780 between a closed, or clamped, position(FIGS. 75A and 75D) and an open, or unclamped, position (FIGS. 75B and75C). While the anvil 3760 is being opened, referring to FIG. 75B, thedrive foot 3780 can be extended to engage and grip tissue. Referring toFIG. 75C, the drive foot 3780 is then retracted to create relativemotion between the distal head 3720 and the patient tissue. Referring toFIG. 75D, the anvil 3760 is movable toward its closed position while thedrive foot 3780 is being retracted and/or after the drive foot 3780 hasbeen retracted. The drive foot 7580 can have teeth which grips thetissue and/or any suitable means for gripping and pulling the tissue. Invarious instances, the drive foot 7580 is configured to apply a vacuumto the tissue in order to grip and pull the tissue. In at least one suchinstance, the vacuum system is off during the operational steps depictedin FIGS. 75A and 75B and on during the operational steps depicted inFIGS. 75C and 75D, for example. In such instances, the vacuum can alsohold the tissue in the distal head 7520 as the anvil 7560 is beingclosed, although other embodiments are envisioned in which the vacuum isoff during the operation step depicted in FIG. 75D.

Referring now to FIGS. 65-69, a stapling instrument 3500 comprises adistal head 3520 including an anvil 3560 and a tissue drive systemincluding a vacuum supply line 3570, two vacuum graspers 3580, and twograsper extenders 3590. The vacuum supply line 3570 comprises a manifold3571 configured to deliver a vacuum pressure differential to the twograsper extenders 3590 and the two vacuum graspers 3580. Each grasperextender 3590 comprises a bellows 3591 in communication with themanifold 3571 which contracts and extends when a vacuum is communicatedto the inner plenum of the bellows 3591. When the bellows 3591 contract,they extend the graspers 3580 to the position illustrated in FIG. 65.Each bellows 3591 is in fluid communication with a cavity 3581 definedin a grasper 3580 which allows a vacuum pressure differential to becommunicated to grasper holes 3582 defined in a tissue engaging surface3585 of the grasper 3580. This vacuum pressure differential at thegrasper holes 3582 can hold the patient tissue against the tissueengaging surface 3585.

As discussed above, the extension of the graspers 3580 grasperscorresponds with the application of a vacuum pressure differential tothe tissue. When the vacuum supply line 3570 no longer supplies a vacuumpressure differential to the bellows 3591, the bellows 3591 willresiliently re-expand and contract and, correspondingly, retract thegraspers 3580, as illustrated in FIG. 67. Similarly, the bellows 3591may also re-expand and retract the graspers 3580 when the vacuumpressure differential is reduced. In either event, the vacuum pressuredifferential at the grasper holes 3582 may lessen as the graspers 3580are being retracted. In some instances, the remaining vacuum pressuredifferential at the grasper holes 3582 may be sufficient to pull thepatient tissue into a tissue chamber 3525 in the distal head 3520. Inother instances, the remaining vacuum pressure differential at thegrasper holes 3582, alone, may not be sufficient to pull the patienttissue into the tissue chamber 3525. With this in mind, the graspers3580 comprise flexible teeth 3586 extending from the tissue engagingsurfaces 3585 thereof. When the graspers 3580 are being extended,referring to FIG. 66, the flexible teeth 3586 slide over the patienttissue without snagging, or at least significantly snagging, on thepatient tissue. This relative movement is also facilitated by thetransverse angle in which the teeth 3586 extend from the tissue engagingsurface 3585. When the graspers 3580 are being retracted, referring toFIG. 68, the teeth 3586 bite into the patient tissue and pull thepatient tissue into the tissue chamber 3525. Again, this is facilitatedby the angle of the teeth 3586 and can compensate for a loss of vacuumpressure differential at the grasper holes 3582.

Once the patient tissue is positioned in the tissue chamber 3525, thetissue can be stapled and/or incised. The supply line 3570 does notsupply a vacuum pressure differential during the stapling and/or cuttingoperations as doing so may extend the graspers 3580 and move the tissue.That said, the vacuum supply could be turned on during the staplingand/or cutting operations if there was, for example, another way to holdthe tissue in place. In either event, the anvil 3560 can thereafter bere-opened, the distal head 3520 can be moved relative to the tissue, andthe vacuum supply can be used to re-extend the tissue graspers 3580 sothat the above-described process can be repeated, as illustrated in FIG.69.

Referring to FIGS. 70-73, a stapling instrument 3600 comprises a distalstapling head 3620 including a staple firing system 3650, an anvil 3660,a tissue cutting system 3640 and, also, a tissue grasping system thatutilizes vacuum pressure differentials. The stapling instrument 3600 issimilar to the stapling instrument 3500 in many respects, most of whichwill not be discussed herein for the sake of brevity. That said, thetissue grasping system comprises two separate and distinct vacuum supplylines—a first supply line 3670 a in communication with a first bellows3690 a which is in fluid communication with a first tissue drive foot3680 a via a foot manifold 3685 a and, also, a second supply line 3670 bin communication with a second bellows 3690 b which is in fluidcommunication with a second tissue drive foot 3680 b via a foot manifold3685 b. The foot manifold 3685 a comprises an array of manifoldapertures 3686 which are in communication with foot apertures 3682defined in the first foot 3680 a and communicate a vacuum pressuredifferential to the foot apertures 3682 when a vacuum is supplied to thefirst supply line 3670 a. The foot manifold 3685 b comprises an array ofmanifold apertures 3686 which are in communication with foot apertures3682 defined in the second foot 3680 b and communicate a vacuum pressuredifferential to the foot apertures 3682 when a vacuum is supplied to thesecond supply line 3670 b. The stapling instrument 3600 furthercomprises a control system configured to selectively apply a vacuum tothe first supply line 3670 a and the second supply line 3670 b such thatthe first drive foot 3680 a and the second drive foot 3680 b can beselectively extended and retracted. In some instances, the feet 3680 aand 3680 b are synchronized and simultaneously extended and retractedtogether while, in other instances, the feet 3680 a and 3680 b areextended and retracted at different times.

An alternative embodiment of a stapling instrument 3600′ is illustratedin FIG. 74. The stapling instrument 3600′ is similar to the staplinginstrument 3600 in many respects. That said, the instrument 3600′comprises larger tissue drive feet 3680′ that have more vacuum holes3682 defined therein as compared to the tissue drive feet 3680 of thestapling instrument 3600.

Referring now to FIGS. 47A-47G, a stapling instrument 3000 comprises adistal head 3020 including a staple firing system, an anvil closuresystem including an anvil 3060, a tissue drive including at least onedrive foot 3080, and a tissue gripper 3070 configured to releasably holdthe tissue. Referring to FIG. 47A, the anvil 3060 is movable from aclamped position to an unclamped position to unclamp the patient tissueT. Referring to FIG. 47B, the tissue gripper 3070 is engageable with thepatient tissue T to hold the tissue in place while the drive foot 3080is extended, which is illustrated in FIGS. 47C and 47D. The tissuegripper 3070 can be engaged with the tissue as the anvil 3060 is beingopened and/or after the anvil 3060 has been opened. In either event,referring to FIG. 47E, the tissue gripper 3070 is disengaged from thetissue before the drive foot 3080 is retracted to pull the distal head3020 relative to the tissue and position the distal head 3020 at a newposition along the staple firing path, as illustrated in FIG. 47F. Atsuch point, referring to FIG. 47G, the patient tissue is clamped by theanvil 3060 and the staple firing system is operated to staple thetissue. At such point, the above-described cycle can be repeated.

As illustrated in FIGS. 47D-47F, the drive foot 3080 is in fluidcommunication with a vacuum source 3090. Similar to the above, the drivefoot 3080 can utilize a vacuum pressure differential from the vacuumsource 3090 to grip the patient tissue. Also similar to the above, thevacuum pressure differential from the vacuum source 3090 can be used toextend the drive foot 3080. That said, the drive foot 3080 can beextended using any suitable mechanism.

Referring again to FIG. 78, the stapling instrument 3900 furthercomprises tissue grippers 3970. The tissue grippers 3970 are useable inconjunction with the drive feet 3980 in the same, or a similar manner,that the tissue grippers 3070 are used in conjunction with the drivefoot 3080.

FIGS. 45, 46, 48, and 49 depict the operational sequencing of a staplinginstrument which could be used with a stapling instrument disclosedherein, such as a stapling instrument 4000 and/or the staplinginstrument 3900 discussed above, for example. The stapling instrument4000 is similar to the other stapling instruments disclosed herein inmany respects, most of which will not be discussed herein for the sakeof brevity. The stapling instrument 4000 comprises an anvil drive system4060, a staple firing system 4050, a tissue cutting system 4040, atissue gripping system 4090, and a tissue drive system 4080 configuredto move the stapling instrument 4000 relative to the patient tissue.FIG. 49 depicts the operational steps of the stapling instrument 4000,which occur in the order presented. For instance, step 4003 follows step4002 and step 4002 follows step 4001, and so forth. That said, it shouldbe understood that adjacent operational steps can occur simultaneously,or with at least some amount of overlap, as illustrated in FIG. 46 anddiscussed in greater detail below. Moreover, the operational steps ofFIG. 49 can be re-arranged in any suitable order.

Referring again to FIG. 49, the operational step 4001 comprises loadinga staple cartridge into the stapling instrument 4000 and/or pushing astaple cartridge into position within the stapling instrument 4000. Theoperational step 4002 comprises removing staples from the staplecartridge and the operational step 4003 comprises placing the staples inposition within the staple firing drive 4050. The operational step 4004comprises articulating the end effector of the stapling instrument 4000,if needed. That said, the operational step 4004 can also occur beforeand/or during the steps 4001, 4002, and/or 4003. The operational step4005 comprises positioning the end effector on the patient tissue andthe operational step 4006 comprises operating the anvil drive system4060 to clamp the anvil on the tissue. The operational step 4005 canalso occur before the operational step 4004.

Further to the above, the operational step 4007 comprises forming thestaples against the anvil and the operational step 4008 comprisesdeploying the knife of the tissue cutting system 4040. The operationalstep 4007 occurs before the operational step 4008, but the steps 4007and 4008 could occur at the same time or with some amount of overlap.The operational step 4009 comprises using the tissue cutting system 4040to retract the knife and it follows the operational step 4008. Theoperational step 4010 comprises gripping and holding the patient tissuepositioned within the end effector of the stapling instrument 4000 usingthe tissue gripping system 4090. The operational step 4011 comprisesunclamping the anvil using the anvil drive system 4060. In suchinstances, the stapling instrument 4000 can hold the tissue even thoughthe anvil is open as a result of the tissue gripping system. Theoperational step 4012 comprises advancing the feet of the tissue drivesystem 4080. The operational step 4013 comprises actuating the tissuegripping system 4090 to ungrip the tissue and the operational step 4014comprises retracting the feet of the tissue drive system 4080 andadvancing the stapling instrument 4000 relative to the tissue.

Further to the above, FIG. 46 illustrates that certain operational stepscan occur at the same time or with some amount of overlap. For instance,the step 4011 of opening the anvil and the step 4001 of loading a staplecartridge into position can occur at the same time or with at least someoverlap. Similarly, the step of 4002 and/or 4003 comprising advancingstaples into position within the staple firing drive 4050 can occur atthe same time as, or with some overlap with, the step 4011 of openingthe anvil, the step 4010 of gripping the tissue with the tissue grippingsystem 4090, the step 4012 of extending the feet of the tissue drivesystem 4080, the step 4013 of releasing the tissue with the grippingsystem 4090, and/or the step 4014 of retracting the feet of the tissuedrive system 4080, for example. Moreover, the step 4001 of reloadinganother staple cartridge into position within the stapling instrument4000 can occur at the same time, or with some overlap with, the step4008 of cutting the tissue and/or the step 4009 of retracting the tissuecutting knife.

Further to the above, FIG. 45 illustrates the actuation cycles of theanvil drive system 4060 and the tissue drive system 4080 of the staplinginstrument 4000. The actuation cycles in FIG. 45 are plotted withrespect to time t, wherein the 0, or zero, demarcations on thehorizontal time axes represent the beginning of a cycle sequence of thestapling instrument 4000. Referring to the actuation cycle of the anvildrive system 4060, the peak 4006 correlates with the step 4006,discussed above, which comprises closing, or clamping, the anvil ontotissue. Similarly, the dwell 4011 correlates with the step 4011,discussed above, which comprises opening, or unclamping, the tissue.Referring now to the actuation cycle of the tissue drive system 4080,the peak 4012 correlates with the step 4012 which comprises extendingthe feet of the tissue drive system 4080 and the peak 4014 correlateswith the step 4014 which comprises retracting the feet of the tissuedrive system 4080 and driving the stapling instrument 4000 relative tothe patient tissue. Upon comparing the actuation cycles for the anvildrive system 4060 and the tissue drive system 4080, it can be seen thatthe anvil is open, or is being opened, when the feet are being extended.Moreover, it can be seen that the anvil is open when the feet are beingretracted and that the anvil is closed at the beginning of the nextcycle of the stapling instrument 4000.

As discussed above, it can be desirable to perform certain operationalsteps of the stapling instrument 4000 sequentially and other operationalsteps at the same time. In some instances, however, it may not bedesirable to perform certain operational steps at the time. As such, thestapling instrument 4000 is configured to lockout certain drive systemsand prevent them from being operated while other drive systems of thestapling instrument 4000 are being operated. Lockouts can includemechanical lockouts and/or electrical lockouts, for example. All of thedrive systems of the stapling instrument 4000 are motorized and incommunication with the controller of the stapling instrument 4000 and,as such, the controller can be used to lockout the drive systems. Thecontroller comprises a microprocessor, for example, which is configuredto electronically lockout one or more drive systems during the operationof one or more other drive systems. FIG. 48 is a chart which illustrateswhich operational steps are prevented from being performed during theperformance of other operational steps. For instance, during the step4001 in which a staple cartridge is loaded into position, all of theother operational steps are locked out, or prevented from happening,other than the step 4004 which articulates the end effector of thestapling instrument 4000, the step 4005 which positions the staplinginstrument 4000 relative to the tissue, and the step 4011 which unclampsthe anvil. In this example, the staple firing system 4050, the tissuedrive system 4080, and the tissue gripping system 4090 are locked out.This is just one example. Other steps could be unlocked during the step4001 if it was determined that doing so was not detrimental, orunacceptably detrimental, to the operation of the stapling instrument4000.

Referring to FIGS. 90A-90D, a stapling instrument 4300 comprises adistal head 4320 including a staple firing system 4350, an anvil drivesystem including an anvil 4360, and a tissue cutting system 4340. Thestapling instrument 4300 is similar to the stapling instrument 1000 andstapling instrument 4400 in many respects, most of which will not bediscussed herein for the sake of brevity. The stapling instrument 4300further comprises upper feet 4370 a and 4370 b and lower feet 4380 a and4380 b. Similar to the feet 4480 of the stapling instrument 4400, thefeet 4370 a, 4370 b, 4380 a, and 4380 b are rotatable between extended(FIG. 90A) and retracted (FIGS. 90B-D) positions to move the distal head4320 relative to the patient tissue T. Referring to FIG. 90A, the feet4370 a and 4380 a comprise a first synchronized pair of feet that movetogether and grab the patient tissue when they are moved into theirextended position. In such instances, the feet 4370 a and 4380 a aremoved toward one another to apply a compressive force or pressure to thetissue. When the feet 4370 a and 4380 a are retracted, referring to FIG.90B, the feet 4370 a and 4380 a pull on the tissue to move the distalhead 4320 relative to the tissue. Once the feet 4370 a and 4380 a havebeen retracted, referring to FIG. 90C, the staple firing system 4350 andtissue cutting system 4340 staple and cut the patient tissue. The staplefiring system 4350 and tissue cutting system 4340 are operatedsimultaneously; however, the staple firing system 4350 could be operatedbefore the tissue cutting system 4340. That said, cutting the tissuebefore stapling it may result in unnecessary bleeding. Notably, though,the feet 4370 a and feet 4380 a apply a clamping pressure to the tissuewhile the stapling instrument 4300 staples and cuts the tissue. Once thetissue has been stapled and incised, referring to FIG. 90D, the feet4370 a and 4380 a are moved away from the tissue to unclamp the tissue.

As discussed above, the feet 4370 a and 4380 a are operably coupledtogether such that they move together as a pair. They rotate together asa pair, they clamp together as a pair, and they unclamp together as apair. Various alternative embodiments are envisioned in which only oneof the feet 4370 a and 4380 a moves to clamp and unclamp the tissue;however, the feet 4370 a and 4380 a would still rotate together as apair. A second synchronized pair of feet including feet 4370 b and 4380b move in the same manner as the first synchronized pair of feetincluding feet 4370 a and 4380 a and, as such, a discussion of theirmotion will not be repeated for the sake of brevity. That said, themotion of the first pair of feet is synchronized with the motion of thesecond pair of feet. More specifically, the second pair of feet areextended at the same time that the first pair of feet are extended, thesecond pair of feet are clamped to grip the tissue at the same time thatthe first pair of feet are clamped, the second pair of feet areretracted at the same time that the first pair of feet are retracted,and the second pair of feet are unclamped at the same time that thefirst pair of feet are unclamped. In certain instances, the motion ofthe first pair of feet and the second pair of feet are not synchronized,or entirely synchronized. In at least one such instance, the first pairof feet is extended and retracted independently of the second pair offeet to turn the distal head 4320 along a curved staple path.

As discussed above, the stapling instruments disclosed herein areconfigured to staple the tissue of a patient. They are also configuredto cut the tissue. Referring to FIGS. 95 and 96, a stapling instrument5000 comprises a distal head 5020 including a staple firing system, atissue cutting system 5040, and an anvil 5060 configured to deform thestaples deployed by the staple firing system. The tissue cutting system5040 comprises a knife bar 5042 which includes a knife edge 5045 definedat the distal end 5044 thereof. In use, the knife bar 5042 istranslatable laterally through the distal head 5020 during a tissuecutting stroke. The tissue cutting stroke of the knife bar 5042 extendsbetween a first, unactuated position, illustrated in FIG. 95, and asecond, actuated, position. During the tissue cutting stroke, the knifeedge 5045 extends between a tissue compression surface 5025 and a tissuecompression surface 5065 defined on the anvil 5060. The knife edge 5045can also extend into the distal head 5020 and/or the anvil 5060 duringthe tissue cutting stroke to assure that the entire thickness of thetissue is transected.

Further to the above, the distal head 5020 defines a longitudinal headaxis HA. During the tissue cutting stroke, the knife bar 5042 movesorthogonally relative to the longitudinal head axis HA. The tissuecutting system 5400 further comprises a cutting actuator 5046 configuredto engage the knife bar 5042 and displace the knife bar 5042 laterally.The cutting actuator 5046 comprises a distal end 5047 which includes anangled cam surface configured to engage a corresponding cam surface 5043defined on the distal end 5044 of the knife bar 5042. The cuttingactuator 5046 can also be configured to push the knife bar 5042 in anysuitable manner. In other embodiments, the knife bar 5042 can be movedwithout a cutting actuator 5046.

Referring to FIG. 98, a stapling instrument 5100 comprises a distal head5120 including a staple forming anvil 5160. The stapling instrument 5100further comprises a staple feeding system 5190, a staple alignmentsystem 5180, and a staple firing system 5150. The staple firing system5150 comprises staple drivers 5151 which are movable longitudinally toeject a set, or cluster, of staples 5130 from the distal head 5120during a staple firing stroke. Referring to FIGS. 99 and 100, eachstaple 5130 comprises a base 5131 and staple legs 5132 extending fromthe base 5131. Referring to FIGS. 100 and 101, the staple drivers 5151are configured to push on the bases 5131 of the staples 5130 to push thestaples legs 5132 against forming pockets 5162 (FIG. 97) defined in theanvil 5160 during staple firing stroke. At such point, referring to FIG.102, the staple drivers 5151 are returned to the starting, or unfired,point of the staple firing stroke so that another staple firing strokecan be performed.

As described above, the stapling instrument 5100 is configured to deploystaples during each staple firing stroke. Referring to FIG. 103, thestapling instrument 5100 further comprises a tissue cutting knife 5140configured to cut the tissue during and/or after each staple firingstroke. The staple firing system 5150 is configured to deploy a firstgroup, or cluster, of three staples 5130 positioned on a first side of acutting path CP created by the knife 5140 and a second group, orcluster, of three staples 5130 positioned on a second side of thecutting path CP. The staple firing system 5150 deploys the first andsecond staple groups at the same time; however, embodiments areenvisioned in which the first group is deployed before the second staplegroup. Alternative embodiments are envisioned in which a staplinginstrument does not comprise a tissue cutting system, or the tissuecutting system of the stapling instrument can be deactivated. The staplefeeding system 5190 and the staple alignment system 5180 co-operate toreposition another set of staples 5130 in the distal head 5120 aftereach staple firing stroke is performed so that another staple firingstoke can be performed. In various instances, the staples 5130 arereloaded during the tissue cutting stroke and/or after the tissuecutting stroke.

Referring primarily to FIGS. 97, 100, and 102, the staple feeding system5190 comprises staple pushers 5191. Each staple pusher 5191 isconfigured to push a staple 5130 into a staple cavity 5121 defined inthe distal head 5120. Further to the above, the distal head 5120comprises six staple cavities 5121 which are each configured to receivea staple 5130 from the staple feeding system 5190. The staples 5130 arearranged in six stacks, or columns, which are aligned with the staplecavities 5121. The staple pushers 5191 push on the bases 5131 of theproximal-most staples 5130 in each staple stack in order to push thedistal-most staples 5130 of each staple stack into the staple cavities5121 during a pushing stroke. The staple pushers 5191 load staples 5130into the staple cavities 5121 at the same time, i.e., during a commonpushing stroke; however, in alternative embodiments, the staple pushers5191 can be configured to sequentially load the staples 5130 into thestaple cavities 5121. Referring to FIGS. 98 and 99, the staples 5130within a staple stack are releasably attached to one another by at leastone adhesive 5135, for example. As illustrated in FIG. 100, the staples5130 of each staple stack are adhered to one another at angle which istransverse to a firing axis FA of a staple firing system driver 5151.The distal head 5120 comprises cam surfaces 5122 which orient and alignthe staples 5130 with the firing axes FA of the staple firing systemdrivers 5151 before the staple firing stroke of the staple firing system5150 is performed.

The staple drivers 5151 and the staple pushers 5191 move parallel, or atleast substantially parallel, to one another. Owing to the design of thestaple drivers 5151 and the staple pushers 5191, and/or other spaceconstraints, referring to FIGS. 97 and 103, the stapling instrument 5100further includes a staple alignment system comprising staple pushers5180 which are configured to work with the staple pushers 5191 to alignthe staples 5130 with the staple drivers 5151. The staple pushers 5191push the staples 5130 longitudinally and the staple pushers 5180 pushthe staples 5130 laterally.

Referring to FIGS. 104-105D, a stapling instrument 5200 comprises adistal head 5220 including a staple firing system 5250 configured todeploy staples 5230, a tissue cutting system, and an anvil 5260including forming pockets configured to deform the staples 5230. Thestaple firing system 5250 comprises rotatable actuators 5252 configuredto displace lateral staple drivers 5254 along linear, or at leastsubstantially linear, lateral paths. Each rotatable actuator 5252comprises a cam 5253 configured to engage a shoulder 5255 defined on thestaple drivers 5254 and displace the drivers 5254 laterally, asillustrated in FIG. 105B. The staple firing system 5250 furthercomprises one or more springs 5224 positioned intermediate the lateralstaple drivers 5254 and a frame 5222 of the distal head 5220. Thesprings 5224 are compressed as the staple drivers 5254 are slidlaterally by the rotatable actuators 5252 until the cams 5253 disengagefrom the shoulders 5255 of the drivers 5254 during the continuedrotation of the actuators 5252, as illustrated in FIG. 105C. At suchpoint, referring to FIG. 105D, the springs 5224 resiliently return thelateral staple drivers 5254 back into their unactuated positions.

Referring to FIGS. 104 and 105A, the staple firing drive 5250 furthercomprises longitudinal staple drivers 5257 which are driven alonglongitudinal staple firing paths by the lateral staple drivers 5254.Each lateral staple driver 5254 comprises a drive cavity 5256 definedtherein which receives a portion of a longitudinal staple driver 5257therein. More specifically, each longitudinal staple driver 5257comprises a cam portion positioned in a drive cavity 5256 which isdriven longitudinally, as illustrated in FIG. 105B, by a cam surface5258 defined in the drive cavity 5256 when the lateral staple drivers5254 are move laterally. As a result of the above, the rotationalmovement of the rotatable actuators 5252 is converted to the lateraltranslation of the lateral staple drivers 5254, which is converted tothe longitudinal translation of the longitudinal staple drivers 5257.The longitudinal motion of the of staple drivers 5257 drives the staples5230 against the anvil 5260 to deform the staples 5230, as illustratedin FIG. 105B. The longitudinal staple drivers 5257 comprise staplecradles 5251 defined therein which are configured to support the staples5230 as the staples 5230 are being deformed.

Further to the above, referring to FIG. 105C, the return lateral motionof the staple drivers 5254 withdraws the longitudinal staple drivers5257 back into their unactuated positions. More specifically, the drivecavities 5256 further comprise a cam surface 5258′ configured to drivethe longitudinal staple drivers 5257 in an opposite direction until thestaple drivers 5257 are reset in their unactuated, or unfired,positions, as illustrated in FIG. 105D. Notably, the anvil 5260 is movedinto an open position when the longitudinal staple drivers 5257 areretracted. At such point, the distal head 5220 can be moved relative tothe tissue, staples 5230 can be reloaded into the distal head 5220, andthe anvil 5260 can be re-clamped onto the tissue, as illustrated in FIG.105A wherein another staple firing stroke of the staple firing drive5250 can be performed.

As described above, columns of connected staples can be used to supply,and re-supply, the staple firing system of a stapling instrument. Inother instances, entire staple cartridges can be used to supply, andre-supply, a staple firing system. Referring to FIG. 106, a staplinginstrument 5300 comprises a shaft 5310, a distal head 5320, and anarticulation joint 5370 rotatably connecting the distal head 5320 to theshaft 5310. The stapling instrument 5300 further comprises a pluralityof staple cartridges 5330″ stored in the shaft 5310 and a cartridgepusher system configured to push the staple cartridges 5330″ into thedistal head 5320. Once a staple cartridge 5330″ is positioned in thedistal head 5320, the staples 5330 (FIG. 107) contained in the staplecartridge 5330″ can be separated and deployed by a staple firing system,as discussed in greater detail below. In various instances, the staplecartridge comprises a cartridge body which is broken up and deployedwith the staples, while in other instances, the staples are ejected fromthe cartridge body and the cartridge body is not implanted.

Further to the above, referring to FIG. 107, the staple cartridge 5330″comprises a cartridge body 5333 including an aperture defined therein.The aperture includes a first side 5334 configured to receive and storea first group of staples 5330 and a second side 5335 configured toreceive and store a second group of staples 5330. The first group ofstaples 5330 is deployed on a first side of a tissue incision pathcreated by a tissue cutting knife and the second group of staples 5330is deployed on a second side of the tissue incision path. The staples5330 are further arranged in clusters 5330′ of three staples which aredeployed together, although staple clusters can include any suitablenumber of staples. Five staple clusters 5330′ are stored in the firstside 5334 of the cartridge body 5333 and five staple clusters 5330′ arestored in the second side 5335 of the cartridge body 5333, although anysuitable number of clusters could be used. A staple cluster 5330′ isejected from each side 5334 and 5335 of the cartridge body 5333 anddeformed against an anvil 5360 during each staple firing stroke of thestapling system. In various alternative embodiments, the staple clusters5330′ can be sequentially deployed from the first and second sides 5334and 5335.

Further to the above, the staples 5330 of each staple cluster 5330′ areattached to one another by at least one adhesive; however, the stapleclusters 5330′ themselves are not attached to one another and are,instead, stored side-by-side in the cartridge body 5333. In at least onealternative embodiment, the staples of adjacent staple clusters arereleasably attached to one another. Referring now to FIG. 108, thecartridge body 5333, for example, can be configured to releasably storea plurality of staple clusters 5430′ therein wherein each staple cluster5430′ comprises three staples. The three staples 5430 of each staplecluster 5430′ are attached to one another by at least one adhesive 5435and, also, the staple clusters 5430′ are attached to one another by atleast one adhesive 5435. In such embodiments, the staple clusters 5430′are attached to one another to form a staple strip 5430″, wherein one ormore staple clusters 5430′ are detached from the other staple clusters5430′ to load the distal head 5320 with staples. Although the stapleclusters of the embodiments described above comprise three staples, astaple cluster can include any suitable number of staples including twostaples, for example, or more than three staples.

Referring to FIGS. 109 and 110, a stapling instrument 5400 comprises ashaft 5410, a distal head, a staple loading system, a staple firingsystem, a tissue cutting system, an anvil closure system, and a systemconfigured to move the distal head relative to the tissue of a patient.The stapling instrument 5400 further comprises the staple strip 5430″ ofFIG. 108 stored in the shaft 5410. The staple strip 5430″ can be storedwithin the cartridge body 5333, as described above, or it can be storedwithin the shaft 5410 without the cartridge body. The staple strip 5430″can comprise any suitable number of staples and/or staple clusters. Inat least one instance, the staple strip 5430″ comprises 588 staples, forexample.

Referring to FIGS. 111 and 112, a stapling instrument 5500 comprises ashaft 5510, a distal head, a staple loading system, a staple firingsystem, a tissue cutting system, an anvil closure system, and a systemconfigured to move the distal head relative to the tissue of a patient.The stapling instrument 5500 further comprises a first staple strip 5530a″ and a second staple strip 5530 b″ stored in the shaft 5510. Thestaple strips 5530 a″ and 5530 b″ are comprised of staples 5430 whichare arranged in staple clusters 5430′. The staple strips 5530 a″ and5530 b″ are nested such that the bases of the staples 5430 face inopposite directions.

Referring to FIGS. 113 and 114, a stapling instrument 5600 comprises ashaft 5610, a distal head, a staple loading system, a staple firingsystem, a tissue cutting system, an anvil closure system, and a systemconfigured to move the distal head relative to the tissue of a patient.The stapling instrument 5600 further comprises a first staple strip 5630a″ and a second staple strip 5630 b″ stored in the shaft 5610. Thestaple strips 5630 a″ and 5630 b″ are comprised of staples 5430 whichare arranged in staple clusters 5430′. The staple strips 5630 a″ and5630 b″ are arranged in a side-by-side manner such that the bases of thestaples 5430 face the same direction.

Referring again to FIG. 106, the stapling instrument 5300 comprises asystem for pushing a staple cartridge 5330″ from the shaft 5310 into thedistal head 5320. Notably, this cartridge pushing system pushes thestaple cartridges 5330″ through the articulation joint 5370 into thedistal head 5320. As a result, the size of the staple cartridges 5330″,and/or staples 5330, may be limited by the space constraints of thearticulation joint 5370, especially when the distal head 5320 isarticulated. FIGS. 115-118 disclose a stapling instrument 5700comprising flexible staple strips which can feed staples into a distalhead through an articulation joint. The stapling instrument 5700includes a first staple strip 5730′ comprising staples 5730 attached toa first carrier 5760′. More specifically, the staples 5730 are attachedto the first carrier 5760′ at tabs 5761′. Each staple 5730 comprises abase 5731 and legs 5732 extending therefrom, wherein the base 5731 isconnected to the first staple strip 5730′ by a tab 5761′. The staplinginstrument 5700 further includes a second staple strip 5730″ comprisingstaples 5730 attached to a second carrier 5760″ at tabs 5761″. Thecarriers 5760′ and 5760″ each comprise an array of apertures 5762 which,as described in greater detail below, are used to feed the staple strips5730′ and 5730″ into the distal head of the stapling instrument 5700.

The staple strip 5730′ is stored in a shaft of the stapling instrument5700. In its stored state, the staple strip 5730′ is planar, or at leastsubstantially planar. More specifically, referring to FIGS. 115 and 116,the staples 5730 are attached to the first carrier 5760′ such that theylie in-plane with the first carrier 5760′. The stapling instrument 5700further comprises a staple feeding system including a drive wheel whichis configured to push the staple strip 5730′ in the distal head of thestapling instrument 5700. The drive wheel comprises an array of drivepins extending therearound which are configured to engage the apertures5762 of the first carrier 5760′ and drive the first carrier 5760′ intothe distal head. The second staple strip 5730″ is also stored in theshaft of the stapling instrument 5700. In its stored state, the staplestrip 5730″ is planar, or at least substantially planar. Morespecifically, referring to FIGS. 115 and 116, the staples 5730 areattached to the second carrier 5760″ such that they lie in-plane withthe second carrier 5760″. Similar to the above, a drive wheel of thestaple feeding system is configured to engage the apertures 5762 of thesecond carrier 5760″ and drive the second carrier 5760″ into the distalhead of the stapling instrument 5700.

Referring to FIGS. 115 and 118, the staple strips 5730′ and 5730″ arestored in a face-to-face arrangement such that the carriers 5760′ and5760″ of the staple strips 5730′ and 5730″ can be engaged and driven onopposite sides by the staple feeding system. As the staple strips 5730′and 5730″ are being fed into the distal head, referring to FIG. 116, thestaples 5730 are bent downwardly about the tabs 5761′ and 5761″ of thestaple strips 5730′ and 5730″, respectively. In at least one instance,the frame of the distal head comprises cam surfaces configured to bendthe staples 5730 downwardly. In certain instances, the staplinginstrument 5700 comprises one or more actuators configured to bend thestaples 5730 downwardly about a mandrel positioned under the tabs 5761′and 5761″, for example. Once displaced into their downward positions,the staples 5730 are detached from the staple strips 5730′ and 5730″. Inat least one instance, the frame of the distal head comprises one ormore shear surfaces, or knife edges, configured to separate the staples5730 from the tabs 5761′ and 5761″ as the staple strips 5730′ and 5730″are advanced into the distal head. In certain instances, the staplinginstrument 5700 further comprises one or more shears that are actuatedto separate the staples 5730 from the staple strips 5730′ and 5730″. Ineither event, the separated staples are then positioned to be deployedby the staple firing system of the stapling instrument 5700.

Further to the above, the stapling instrument 5700 is configured toseparate a cluster of staples from the staple strips 5730′ and 5730″ andthen advance the carriers 5760′ and 5760″ of the staple strips 5730′ and5730″ so that another cluster of staples can be separated from thestaple strips 5730′ and 5730″. Once the staples 5730 have been separatedfrom the carriers 5760′ and 5760″, referring to FIG. 118, the empty, orstripped, portions of the carriers 5760′ and 5760″ are fed back into theshaft of the stapling instrument 5700. As a result, the motion whichfeeds new staples 5730 into the staple firing system also feeds theempty carriers 5760′ and 5760″ back into the shaft.

Referring to FIG. 119, a staple cluster 5830′ comprises four staples5830 which are adhered together by at least one adhesive 5835. Eachstaple 5830 comprises a base 5831 and two staple legs 5832 extendingfrom the base 5831. Notably, the legs 5832 are not co-planar with thebase 5831. Rather, the base 5831 is present in a base plane and the legs5832 are present in a leg plane. The base plane is parallel, or at leastsubstantially parallel, to the leg plane, although embodiments areenvisioned in which the base plane and the leg plane are not parallel.In either event, two of the staples 5830 of the staple cluster 5830′face inwardly while two of the staples 5830 face outwardly. A staple5830 faces outwardly when its base plane is closer to the center of thestaple cluster 5830′ than its leg plane. Correspondingly, a staple 5830faces inwardly when its leg plane is closer to the center of the staplecluster 5830′ than its base plane.

Further to the above, the staple cluster 5830′ comprises two staples5830 located on a first side of a centerline CL and two staples 5830located on a second side of the centerline CL. The staples 5830 on thefirst side of the staple cluster 5830′ are connected by a first adhesiveconnector 5835 and the staples 5830 on the second side of the staplecluster 5830′ are connected by a second adhesive connector 5835.Moreover, a staple 5830 on the first side of the staple cluster 5830′ isconnected to a staple 5830 on the second side of the staple cluster5830′ by an adhesive connector 5835. That said, a staple cluster cancomprise any suitable number of adhesive connectors. The adhesiveconnectors 5835 releasably hold the staples 5830 together. The adhesiveconnectors 5835 are broken before the staples 5830 are implanted intothe patient tissue; however, alternative embodiments are envisioned inwhich the adhesive connectors 5835 are not broken before the staples5830 are implanted into the patient tissue. The adhesive connectors 5835are comprised of biocompatible and/or bioabsorbable materials, such asbioabsorbable polymers, for example.

Referring to FIG. 120, a stapling instrument 5900 comprises a shaft, adistal head 5920, a staple feeding system, a staple firing system, atissue cutting system, an anvil closing system, and a drive systemconfigured to move the distal head 5920 relative to the patient tissue.The distal head 5920 comprises a first staple cavity 5921 and a secondstaple cavity 5921. Each staple cavity 5921 is configured to store astaple cluster 5930′, or a column of staple clusters 5930′, therein.Each staple cluster 5930′ comprises four staples 5930, although it caninclude any suitable number of staples. Each staple 5930 comprises abase 5931 and two staple legs 5932 extending therefrom. The base 5931and the legs 5932 are co-planar, or at least substantially co-planar.The staples 5930 are releasably connected to one another by at least oneadhesive.

Further to the above, each staple cluster 5930′ comprises one or moreguides 5935. The guides 5935 are defined on the lateral sides of thecluster 5930′ and are configured to be received within notches 5925defined in the staple cavities 5921. More specifically, the guides 5935are closely received by the sidewalls of the notches 5925 such thatthere is little, if any, relative lateral movement between the clusters5930′ and the distal head 5920. To this end, the staple clusters 5930′remain aligned with the forming pockets of the anvil as the staples 5930are deployed. The guides 5935 are comprised of a biocompatible and/orbioabsorbable material, such as a bioabsorbable polymer, for example,and are implantable with the staples 5930.

Referring to FIG. 121, a stapling instrument 6000 comprises, among otherthings, a shaft, a distal head 6020 including an anvil 6060, and astaple firing system. In this embodiment, the staple firing system loadsstaples 6030 into the distal head 6020 and fires them by pushing themagainst the anvil 6060. The distal head 6020 comprises staple cavities6021 defined therein which are configured to store and guide the staples6030 as they are being pushed toward the anvil 6060.

Referring to FIGS. 122-125, a stapling instrument 6100 comprises ashaft, a distal head 6120, a staple loading system, a staple firingsystem, an anvil drive system, a tissue gripping system, and a tissuedrive system configured to move the distal head 6120 relative to thepatient tissue. The drive system of the stapling instrument 6100comprises rotatable feet 6180 which, similar to the above, areconfigured to grip the tissue of a patient and pull the distal head 6120relative to the tissue. Also similar to the above, the tissue grippingsystem is configured to hold the tissue as the feet 6180 are beingextended and/or during any suitable time during the operation of thesurgical instrument 6100. Referring primarily to FIG. 125, the tissuegripping system comprises a tissue holder 6170 configured to engage thetissue of a patient. The tissue holder 6170 comprises a rectangular body6172 and stems 6174 extending from the body 6172. The tissue holder 6170defines a tissue engaging surface 6175 which is smaller than thecross-sectional thickness 6125 of the distal head 6120, which isillustrated in FIG. 124. Owing to the smaller area of the tissueengaging surface 6175 as compared to the cross-sectional thickness 6125,the tissue holder 6170 can apply a larger gripping pressure to thepatient tissue than the distal head 6120 could for a given clampingforce. In at least one instance, the tissue engaging surface 6175 has anarea which is about 25% of the cross-sectional thickness 6125.

Referring to FIGS. 126-137, a stapling instrument 6200 comprises ashaft, a distal head 6220, a staple firing system 6250, a tissue cuttingsystem, an anvil drive system, and a tissue drive system configured tomove the distal head 6220 relative to the tissue of a patient. Referringto FIGS. 126 and 127, the tissue drive system comprises rotatable feet6280 which are moved into an extended position (FIG. 126) and thenretracted (FIG. 127) to grip the patient tissue and move the distal head6220 relative to the tissue. FIG. 128A also illustrates one of the feet6280 in its extended position. The feet 6280 can be extended and thenretracted at the same time to move the distal head 6220 along a straightpath or extended and retracted separately to turn the distal head 6220,but only one foot 6280 is shown in FIG. 128A for the purpose ofillustration. FIG. 128, which corresponds to FIG. 128A, depicts theanvil 6260 in a sufficiently-clamped state so that the anvil 6260 andthe feet 6280 co-operate to grip the patient tissue. Moreover, FIG. 128depicts an unformed staple 6230 positioned in a staple cavity 6221defined in the distal head 6220 and the staple firing system 6250 in anunfired state.

FIG. 129A, similar to FIG. 127, depicts the feet 6280 in their retractedposition. FIG. 129, which corresponds to FIG. 129A, depicts the anvil6260 in a fully-clamped state and the staple firing system 6250 in afired state. As illustrated in FIG. 129, the legs 6232 of the staple6230 have been fully deformed into a B-shaped configuration; however,other deformed configurations of the staple 6230 may be suitable.Referring now to FIGS. 131 and 133, the staple firing system 6250comprises a firing bar 6255 and a plurality of staples 6230 storedwithin recesses 6252 defined in the sides of the firing bar 6255. Afirst column of staples 6230 is stored in a first side of the firing bar6255 and a second column of staples 6230 is stored in a second, oropposite, side of the firing bar 6255. Each of the recesses 6252 isdefined by a proximal staple cradle 6251 configured to push on the base6231 of the staple 6230 positioned therein. FIG. 134 depicts two staples6230 positioned in a staple cavity 6221 defined in the distal head 6220and the firing bar 6255 of the staple firing system 6250 in an unfiredstate.

Referring again to FIG. 134, the sides of the staple cavity 6221comprises recesses 6222 defined therein. The sides of the staple cavity6221 also comprise drag surfaces 6223 positioned intermediate therecesses 6222. When the firing bar 6255 is pushed distally to fire afirst group of staples 6230 positioned in the staple cavity 6221 duringa first staple firing stroke, the staples 6230 stored in the firing bar6255 are pushed by the drag surfaces 6223. As the firing bar 6255 isretracted after the first firing stroke, referring to FIG. 136, thestaples 6230 catch on the drag surfaces 6223 such that the firing bar6255 slides relative to the staples 6230. In such instances, as aresult, the staples 6230 index into the next distal set of recesses 6252defined in the firing bar 6255, thereby presenting a new set of staples6230 to be ejected from the staple cavity 6221. FIGS. 130 and 130Adepict the surgical instrument 6200 as it is being re-opened to releasethe patient tissue so that the distal head 6220 can be repositionedrelative to the patient tissue. Once the distal head 6220 has beensuitably re-positioned, referring to FIG. 137, the firing bar 6255 canbe advanced distally to perform a second staple firing stroke. Thisprocess can be repeated to deploy all of the staples 6230 stored in thefiring bar 6255.

The stapling instruments disclosed herein can be configured to deploystaples in a suitable staple pattern. FIG. 138 depicts one exemplarystaple pattern comprising staples 6330 and staples 6330′ positioned onboth sides of a tissue cut line 6340. Each side of the tissue cut line6340 comprises an inner row of staples 6330 facing away from the cutline 6340 and an outer row of staples 6340 facing toward the cut line6340. FIG. 139 depicts another exemplary staple pattern comprisingstaples 6330, staples 6330′, and staples 6430″. The staples 6430″ arearranged in rows on both sides of the tissue cut line 6340. Morespecifically, the staples 6430″ are arranged in staple rows positionedintermediate both sets of inner row of staples 6330 and outer row ofstaples 6330′.

Referring to FIGS. 140 and 141, a stapling instrument 6500 comprises ashaft 6510, a distal head 6520, and an articulation joint 6270 rotatablyconnecting the distal head 6520 to the shaft 6510. The staplinginstrument 6500 further comprises a staple feeding system 6590configured to manufacture and supply a continuous feed of staples 6530to the distal head 6520. The staple feeding system 6590 comprises aspool 6592 operably coupled to an electric motor. The spool 6592comprises metal wire 6594 wrapped around a central core. The wire 6594is comprised of stainless steel and/or titanium, for example. The wire6594 is fed through a passage 6514 defined in the shaft 6510 and thearticulation joint 6570. In use, the motorized spool 6594 pushes thewire 6594 into the distal head 6520. As described in greater detailbelow, the distal head 6520 further comprises a forming mandrelconfigured to deform the wire 6594 into a staple 6530. The mandrel isdriven by an electric motor and/or actuator, but could be actuated inany suitable manner. As also described in greater detail below, thedistal head 6520 comprises a knife, or shearing member, configured tocut the wire 6594. The shearing member is driven by an electric motorand/or actuator, but could be actuated in any suitable manner. Once thestaple 6530 has been formed and separated from the wire 6594, the staple6530 can be deployed and deformed against an anvil 6560 of the staplinginstrument 6500.

Referring to FIG. 141, the surgical instrument 6500 further comprises astaple forming system 6580 configured to create staples 6530 from thewire 6594. The staple forming system 6580 comprises a forming mandrel6582 positioned in a forming cavity 6522 defined in the distal head6520. The staple forming system 6580 further comprises a formingactuator 6584 configured to engage the wire 6594 and deform the wire6594 within the forming cavity 6522. At such point, the forming mandrel6582 is actuated to sever the staple 6530 from the wire 6594. After thestaple 6530 has been deployed and/or moved out of the forming cavity6522, another staple 6530 can be formed within the cavity 6522. Incertain alternative embodiments, a wire segment is cut from the metalwire 6594 before the wire segment is formed into a staple 6530. Ineither event, the staple 6530 can comprise a substantially U-shapedconfiguration, for example. Alternatively, the wire segment can beformed into a substantially V-shaped configuration. Moreover, thestapling instrument 6500 can be configured to manufacture and deploy anysuitable fastener, such as tacks and/or clamps, for example.

Referring to FIGS. 158 and 159, a stapling instrument 7300 comprises ashaft 7310, a distal head 7320, and an articulation joint 7370 rotatablyconnecting the distal head 7320 to the shaft 7310. In use, the staplinginstrument 7300 is inserted into a patient P through a trocar TC. Thetrocar TC comprises a passage extending there through which permits thedistal head 7320, and a portion of the shaft 7310, to be inserted intothe patient. In other instances, the distal head 7320 can be insertedinto the patient through an open incision without a trocar. In eitherevent, the stapling instrument 7300 is configured to deploy staples froma staple cartridge inserted therein. The shaft 7310 comprises a loadingport 7312 which is in communication with a cartridge passage, orchannel, extending through the shaft 7310, the articulation joint 7370,and the distal head 7320. In use, a staple cartridge, such as staplecartridge 7330′, for example, is inserted into the shaft 7310 throughthe loading port 7312 and then pushed into the distal head 7320. Thestapling instrument 7300 further comprises a cartridge pusher systemconfigured to push the staple cartridge 7330′ into the end effector7300.

In various instances, further to the above, staple cartridges 7330′ canbe fed into the stapling instrument 7300 such that the staplinginstrument 7300 can be continuously operated without having to beremoved from the patient to be reloaded. Each staple cartridge 7330′ hasstaples stored therein which have a first size, such as a first unfiredheight. In certain instances, it is desirable to create a staple linewith staples all having the same size, or unfired height. Such instancescan arise when the tissue being stapled has a substantially uniformthickness. In other instances, it is desirable to create a staple linewith staples having different sizes, or unfired heights. Such instancescan arise when the tissue being stapled does not have a uniformthickness. For instance, stomach tissue transected during a stomachreduction procedure usually does not have a consistent thickness. Insuch instances, a first staple cartridge 7330′ can be loaded into thestapling instrument 7300 that has staples having a first unfired heightand a second staple cartridge 7330″ can be loaded into the staplinginstrument 7300 having a second unfired height. The first unfired heightis taller than the second unfired height, but the first unfired heightcould be shorter than the second unfired height. Similarly, a thirdstaple cartridge 7330′″ can be loaded into the stapling instrument 7300that has staples having a third unfired height which is different thanthe first unfired height and the second unfired height.

Further to the above, more than one staple cartridge can be loaded intothe stapling instrument 7300. The staple cartridges can be inserted intothe stapling instrument 7300 such that they are used in a specificorder. For instance, staple cartridges having shorter unfired heightscan be fired before staple cartridges having taller unfired heights.Alternatively, staple cartridges having taller unfired heights can befired before staple cartridges having shorter unfired heights. In anyevent, the distal-most staple cartridge is used first and theproximal-most staple cartridge is used last. Such an arrangement allowsthe surgical procedure to be pre-planned with little, if any, lost timein loading the stapling instrument 7300 during the surgical procedure.Alternatively, the staple cartridges can be fed into the staplinginstrument 7300 one at a time. Such an arrangement provides a clinicianwith an opportunity to change the order in which the staple cartridgesare ultimately used.

The loading port 7312 comprises an opening accessible from the exteriorof the shaft 7310, although the loading port 7312 could be defined inthe handle of the stapling instrument 7300 or in any other suitablelocation. In various instances, the stapling instrument 7300 can furthercomprise a door configured to cover the loading port 7312. In at leastone instance, the door can be sealed, when closed, to prevent or inhibitthe ingress of fluids and/or contaminants into the stapling instrument7300. In such instances, the door and/or the housing of the shaft 7310can comprise one or more seals.

Referring primarily to FIG. 159, the stapling instrument 7300 comprisesa system for stripping off a cluster of staples, such as staples 7330,for example, from the distal-most staple cartridge. The staplinginstrument 7300 further comprises a staple firing system 7350 configuredto deploy the staples 7330 and deform the staples 7330 against an anvil7360 during a staple firing stroke. The stapling instrument 7300 furthercomprises a tissue drive system 7380 configured to move the distal head7320 relative to the patient tissue after the staple firing stroke.

Referring to FIGS. 168 and 169, a stapling instrument 7900 comprises ashaft 7910, a distal head 7920, and an articulation joint 7970 rotatablyconnecting the distal head 7920 to the shaft 7910. As described ingreater detail below, the distal head 7920 is pivotable in any suitabledirection. Similar to the above, the stapling instrument 7900 comprisesa cartridge feeding system configured to feed staple cartridges 7930′into the distal head 7920 through a cartridge passage 7914 that extendsthrough the shaft 7910, the articulation joint 7970, and the distal head7920. Also similar to the above, staples 7930 are stripped from thedistal-most staple cartridge 7930′ and then fired against an anvil 7960.As described in greater detail below, the stapling instrument 7900further comprises an articulation drive system 7980 configured toarticulate the distal head 7920.

Further to the above, referring again to FIGS. 168 and 169, the distalhead 7920 is articulatable in several directions relative to the shaft7910. The shaft 7910 extends along a longitudinal shaft axis LA and thedistal head 7920 extends along a longitudinal head axis HA. The headaxis HA is aligned, or at least substantially aligned, with the shaftaxis LA when the distal head 7920 is not articulated. When the distalhead 7920 is articulated, the head axis HA is transverse to the shaftaxis LA. Referring to FIG. 168, the distal head 7920 is articulatablelaterally, or in a side-to-side direction. In at least one suchinstance, the distal head 7920 is articulatable within a rangecomprising about 15 degrees to a first side of the shaft axis LA andabout 15 degrees to a second side of the shaft axis LA, for example. Thearticulation drive system 7980 is configured to drive, or activelyarticulate, the distal head 7920 through this range of motion. Thearticulation drive system 7980 comprises a first lateral driver 7982mounted to the distal head 7920 and a second lateral driver 7984 mountedto the distal head 7920 on the opposite side of the distal head 7920. Inuse, the first lateral driver 7982 is pushed and/or the second lateraldriver 7984 is pulled to articulate the distal head 7920 in a firstdirection. Correspondingly, the first lateral driver 7982 is pulledand/or the second lateral driver 7984 is pushed to articulate the distalhead 7920 in a second direction. In at least one instance, the firstlateral driver 7982 comprises a first guide wire and the second lateraldriver 7984 comprises a second guide wire. Such guide wires are suitablefor pulling the distal head 7920.

Referring to FIG. 169, the distal head 7920 is also articulatable in aforward and/or backward direction. In at least one such instance, thedistal head 7920 is articulatable within a range comprising about 25degrees in a backward direction and about 25 degrees in a forwarddirection, for example. In certain embodiments, although notillustrated, the articulation drive system 7980 is configured toactively articulate the distal head 7920 in the forward and backward(FIG. 169) directions. In alternative embodiments, the distal head 7920can be passively articulated in the forward and backward directions. Insuch embodiments, the stapling instrument 7900 does not actively drivethe distal head 7920 relative to the shaft 7910. Instead, the distalhead 7920 can float in the forward-to-backward direction. Similarly, thedistal head 7920 can be passively articulated in the side-to-sidedirection with or without the articulation drive system 7980. In anyevent, the distal head 7920 is articulatable in both the forward-to-backand side-to-side planes and can take a compound angle with respect tothe longitudinal axis LA of the shaft 7910.

In various embodiments, the surgical instrument 7900 can comprise a lockconfigured to hold the distal head 7920 in position which can bereleased to allow the distal head 7920 to move relative to the shaft7910. In various instances, the distal head 7920 can be passivelyarticulated by pushing the distal head 7920 against the patient tissuewithin the surgical site when the distal head 7920 is unlocked. Thedistal head 7920 could also be actively articulated when the distal head7920 is unlocked. In either event, the distal head 7920 can then belocked in its articulated position once the distal head 7920 has beensuitably positioned. In order to return the distal head 7920 to itsunarticulated position, the distal head 7920 can be unlocked and thenre-aligned with the shaft axis LA. In at least one instance, thestapling instrument 7900 comprises one or more springs configured tobias the distal head 7920 into its unarticulated position. In any event,the articulation lock can prevent, or at least inhibit, the back-drivingof the distal head 7920 in response to external and/or internal forcesand torques.

Further to the above, the articulation joint 7970 of the staplinginstrument 7000 permits the distal head 7920 to be articulated about oneor more axes. In various alternative embodiments, the shaft of astapling instrument comprises a first articulation joint which permits adistal head to articulate about a first articulation axis and a secondarticulation joint which permits the distal head to articulate about asecond articulation axis. The first articulation axis and the secondarticulation axis extend in planes which are orthogonal, but can extendin any suitable transverse planes. In various instances, the first andsecond articulation joints are passively articulated. In some instances,the first and second articulation joints are actively articulated. In atleast one instance, the first articulation joint is actively articulatedand the second articulation joint is passively articulated.

Referring to FIG. 170, a stapling instrument 8000 comprises a dampeningsystem 8080 configured to control, or slow, the articulation of thedistal head 7920. The dampening system 8080 comprises a first link 8082,a second link 8084, and a dashpot 8085. The first link 8082 is pinned tothe distal head 7920 at a pivot 8081. The first link 8082 is also pinnedto the second link 8084 at a pivot 8083. The pivots 8081 and 8083 allowthe dampening system 8080 to accommodate the various articulationmotions of the distal head 7920. The dashpot 8085 comprises a housing8087 mounted to the shaft 7910 and a dampening medium 8088 contained ina chamber defined in the housing 8087. The second link 8084 comprises apiston 8086 defined on its proximal end which is positioned in thehousing aperture and is configured to move through the dampening medium8088 when the distal head 7920 is articulated. The dampening medium 8088flows through and/or around the piston 8086, thereby permitting, butslowing, relative movement between the piston 8086 and the housing 8097.Correspondingly, the dampening medium 8088 permits, but slows, themovement of the distal head 7920 relative to the shaft 7910. Suddenmovements of the distal head 7920 may be hard for the clinician tocontrol and/or anticipate and may cause the distal head 7920 to strikethe patient tissue. The dampening medium 8088 can comprise any suitablemedium, such as dampening grease, for example.

Referring to FIG. 171, a stapling instrument 8100 comprises a dampeningsystem 8180 configured to control, or slow, the articulation of thedistal head 7920. The dampening system 8180 comprises a link 8182 and adashpot 8185. The link 8182 is pinned to the distal head 7920 at a pivot8181. The first link 8082 is flexible, thereby allowing the dampeningsystem 8180 to accommodate the various articulation motions of thedistal head 7920. The dashpot 8185 comprises a housing 8187 rotatablymounted to the shaft 7910 and a dampening medium 8188 contained in achamber defined in the housing 8187. The link 8182 comprises a piston8186 defined on its proximal end which is positioned in the housingaperture and is configured to move through the dampening medium 8188when the distal head 7920 is articulated. The dampening medium 8188flows through and/or around the piston 8186, thereby permitting, butslowing, relative movement between the 8186 and the housing 8197.Correspondingly, the dampening medium 8188 permits, but slows, themovement of the distal head 7920 relative to the shaft 7910. Suddenmovements of the distal head 7920 may be hard for the clinician tocontrol and/or anticipate and may cause the distal head 7920 to strikethe patient tissue. The dampening medium 8188 can comprise any suitablemedium, such as dampening grease, for example.

Referring to FIG. 172, the stapling instrument 8100 is insertable into apatient P through a trocar TC and is movable relative to the targettissue T. To a certain extent, the trocar TC can be moved relative tothe patient P and, also to a certain extent, the stapling instrument8100 can be moved relative to the trocar TC. Such movement, however, maycause the shaft 7910 to move through a wide range of angles. In order tokeep the distal head 7920 aligned with the tissue as the distal head7920 is progressed along the staple line, the distal head 7920 can beprogressively articulated backwards, for example. Referring to FIG. 173,the distal head 7920 can be progressively articulated forward and/orbackward to keep the axis of the distal head 7920 orthogonal, or atleast substantially orthogonal, to the target tissue T. In variousinstances, the distal head 7920 is actively articulated by anarticulation drive system to adjust the angle between the distal head7920 and the shaft 7910. In certain instances, the distal head 7920 ispassively articulated by an articulation drive system to adjust theangle between the distal head 7920 and the shaft 7910. In suchinstances, the distal head 7920 can adaptively float to follow thestaple firing path.

Referring to FIGS. 34 and 35, a stapling instrument 2500 comprises ashaft 2510, a distal head 2520, and an articulation joint 2570 rotatablyconnecting the distal head 2520 to the shaft 2510. The shaft 2510extends along a longitudinal shaft axis LA and the distal head 2520extends along a longitudinal head axis HA. The shaft axis LA and thehead axis HA are aligned when the distal head 2520 is not articulated,as illustrated in FIG. 34. Referring to FIG. 35, the head axis HA istransverse to the shaft axis LA when the distal head 2520 isarticulated. The stapling instrument 2500 further comprises a dampeningsystem 2580 configured to control, or slow, the articulation of thedistal head 2520. The dampening system 2580 comprises a first link 2581,a second link 2582, and a dashpot 2585. The first link 2581 is pinned tothe distal head 2520 at a pivot 2584. The first link 2581 is also pinnedto the second link 2582 at a pivot 2583. The pivots 2583 and 2584 allowthe dampening system 2580 to accommodate the various articulationmotions of the distal head 2520. When the distal head 2520 is notarticulated, referring to FIG. 34, the first link 2581 is aligned withthe second link 2582 along a longitudinal axis. When the distal head2520 is articulated, referring to FIG. 35, the first link 2581 istransverse to the second link 2582.

The dashpot 2585 comprises a housing mounted to the shaft 2510 and adampening medium 2586 contained in a chamber defined in the housing. Thesecond link 2582 comprises a piston defined on its proximal end which ispositioned in the housing aperture and is configured to move through thedampening medium 2586 when the distal head 2520 is articulated. Thedampening medium 2586 flows through and/or around the piston, therebypermitting, but slowing, relative movement between the piston and thehousing. Correspondingly, the dampening medium 2586 permits, but slows,the movement of the distal head 2520 relative to the shaft 2510. Thedampening medium 2586 can comprise any suitable medium, such asdampening foam, for example.

A stapling instrument 2000 is illustrated in FIG. 13 and is similar tothe stapling instrument 1000 and/or the other stapling instrumentsdisclosed herein in many respects, most of which will not be discussedherein for the sake of brevity. The stapling instrument 2000 comprises ahandle 2100 including a housing 2110, a grip 2120, and a display 2130.The housing 2110 comprises a connector 2170 which is configured toconnect a shaft assembly, such as shaft assembly 1200, for example, tothe handle 2100. The handle 2100 further comprises a replaceable batterypack 2160 which is releasably attached to the housing 2110 and removablypositioned within a cavity 2115 defined in the housing 2110. The batterypack 2160 supplies power to the display 2130 and/or the motor-drivensystems contained within the handle 2100. As discussed in greater detailbelow, the display 2130 is configured to permit the user to control theoperation of the surgical instrument 2000.

Further to the above, the stapling instrument 2000 comprises a staplefiring system configured to apply a staple line in the tissue of apatient and the display 2130 comprises controls for evaluating thestatus of the staple firing system. The display 2130 also comprisescontrols for evaluating and/or altering the speed in which the staplinginstrument 2000 is applying the staple line, the direction in which thestaple line is being applied, and/or any performance thresholds thathave been met, exceeded, or are about to be exceeded, for example. Thedisplay 2130 comprises a capacitive touchscreen; however, any suitablescreen could be used.

Referring to FIG. 14, the display 2130 comprises a status control 2140.The status control 2140 comprises a window 2141 including a windowheader 2142. The status control 2140 further comprises an image window2145 configured to display information regarding the tissue beingstapled, the staple firing path, and/or any other information that theclinician may use to operate the stapling instrument 2000. For instance,the image window 2145 is configured to display the staple firing path2143 that the stapling instrument 2100 is currently moving along and/oran alternate staple firing path 2143′ which would guide the staple patharound certain anatomical features in the patient tissue T, such as ablood vessel V, for example. The status control 2140 is a digitalcontrol and/or display and is signal communication with a controller ofthe stapling instrument 2000.

Referring to FIG. 17, the display 2130 further comprises a directioncontrol 2190 which is configured to control the direction of the staplefiring path. The direction control 2190 comprises a window 2191including a window header 2192 and an image window 2195. The imagewindow 2195 is configured to display the orientation of the distal headof the stapling instrument relative to an original starting orientation.The image window 2195 comprises a plurality of orientation lines 2194indicating certain direction angles, such as 15 degrees, 30 degrees, and45 degrees, for example, relative to the starting orientation line 2194demarcated as 0 degrees. The image window 2195 further comprises aneedle 2193 which represents the orientation of the distal head of thestapling instrument relative to the starting orientation of the staplinginstrument. The direction control 2190 further comprises an edit window2198 which, once activated, allows the user to alter the direction ofthe staple path by manipulating the needle 2193. The direction control2190 further comprises a save window 2199 which, once activated, allowsthe user to save the input provided to the controller through thedirection control 2190. At such point, the stapling instrument 2000 canmove along its new orientation. The status control 2190 is a digitalcontrol and/or display and is signal communication with the controllerof the stapling instrument 2000.

Referring to FIG. 15, the display 2130 further comprises a speed control2150 configured to control speed in which the stapling instrument 2000creates the staple path. The speed control 2150 comprises a window 2151including a window header 2152 and an image window 2155. The imagewindow 2155 comprises an indicator 2153 configured to display the speedof the stapling instrument. For instance, the indicator 2153 can displaythat number of staple firing strokes that the stapling instrument 2000is performing per minute. The image window 2155 further comprises anup-arrow control 2156 which is actuatable to increase the rate of thestaple firing strokes and a down-arrow control 2157 which is actuatableto decrease the rate of the staple firing strokes. The indicator 2153can be configured to display the speed in which the stapling instrument2000 is being propelled across the patient tissue by the tissue drivesystem. Other metrics for the speed of the stapling instrument 2000 canbe used and displayed. The status control 2150 is a digital controland/or display and is signal communication with the controller of thestapling instrument 2000.

Referring to FIG. 16, the display 2130 further comprises a faultthreshold control 2180 which is configured to manage fault thresholds ofthe stapling instrument 2000 as they arise. For instance, a thresholdfor the force needed to perform a staple firing stroke can be used toestablish a fault condition which requires input from the user. If theforce needed to perform a staple firing stroke exceeds the threshold,the controller of the stapling instrument 2000 can warn the user via thefault threshold control 2180 and/or stop the stapling instrument 2000.Certain faults can be over-ridden, or otherwise managed, by the userwhich can allow the stapling instrument 2000 to continue applying thestaple line. The fault threshold control 2180 permits the user to managethese faults. Other faults may not be over-ridden. In such instances,the fault threshold control 2180 is configured to display to the userthat the fault cannot be over-ridden and/or how to resolve the faultsuch that the operation of the stapling instrument 2000 can becontinued. The fault threshold control 2180 comprises a window 2181including a window header 2182 and an image window 2185. The faultthreshold control 2180 is a digital control and/or display and is signalcommunication with the controller of the stapling instrument 2000.

Turning now to FIG. 18, the stapling instrument 2000 further comprises avision acquisition system, discussed in greater detail below, and thedisplay 2130 further comprises an image window 2135 configured todisplay, among other things, a real-time video image from the visionacquisition system. The display 2130 further comprises a menu 2131extending along the left side of the image window 2135; however, themenu 2131 could be placed in any suitable location on the display 2130.The menu 2131 includes the status control 2140, the speed control 2150,the fault threshold control 2180, and the direction control 2190discussed above. The menu 2131 also includes a settings control 2132which can be used to select and/or re-arrange the windows and/orcontrols on the display 2130. The menu 2131 further includes a stopcontrol 2136 which can immediately stop the progression of the staplinginstrument 2100 along the staple firing path. The menu 2131 is a digitalcontrol and/or display and is signal communication with the controllerof the stapling instrument 2100.

Further to the above, referring again to FIG. 18, the display 2130further comprises a first view window 2133 and a second view window2134. The view windows 2133 and 2134 are positioned along the right sideof the image window 2135, but could be placed in any suitable locationon the display 2130. The view windows 2133 and 2134 provide the userwith alternate views of the stapling instrument 2000. For instance, thefirst view window 2133 provides the user with a side view of thestapling instrument 2000 in the surgical site and the second view window2134 provides the user with a top view of the stapling instrument 2000in the surgical site. These additional views can be supplied by one ormore digital cameras on the stapling instrument 2000 and/or from othersurgical instruments, such as an endoscope, for example, in the surgicalsite. In such instances, the other surgical instruments are in signalcommunication with the controller of the stapling instrument 2000 toprovide these additional images. In certain instances, the controller ofthe stapling instrument 2000 can interpret data provided to thecontroller and generate the additional images for the windows 2133 and2134 based on the provided data.

As discussed above, the speed in which the staple firing system and/orthe tissue drive system of the stapling instrument 2000 is operated canbe controlled by the speed control 2150 on the display 2130. In variousinstances, as discussed above, the speed can be controlled manually, orby an input from the user. In other instances, the controller of thestapling instrument 2000 can control the speed automatically. In suchinstances, the controller is configured to evaluate the properties ofthe tissue being stapled, such as its thickness and/or density, forexample, and adjust the speed of the staple firing system and/or thetissue drive system accordingly. For instance, if the controllerdetermines that the tissue being stapled is thick, or is near, at, orover a tissue thickness threshold, the controller can slow down thespeed of the stapling instrument 2000. Similarly, the controller canslow down the speed of the stapling instrument 2000 if the controllerdetermines that the tissue being stapled is dense, or is near, at, orover a tissue density threshold, for example. Correspondingly, thecontroller can speed up the speed of the stapling instrument 2000 if thecontroller determines that the tissue being stapled is thin or lessdense than usual, for example. Further to the above, referring to FIG.19, the speed control 2150 of the stapling instrument 2000 comprises anoption for the user to select between an automatic speed control 2158 inwhich the stapling instrument 2000 controls the speed of the staplinginstrument 2000 and a manual speed control 2159 in which the usercontrols the speed of the stapling instrument 2000.

Referring to FIG. 20, a stapling instrument 2200 comprises a display2230. The stapling instrument 2200 is similar to the stapling instrument2000 in many respects and the display 2230 is similar to the display2130 in many respects, most of which will not be discussed herein forthe sake of brevity. The display 2230 comprises a menu 2231 and a centerimage window 2235. The center image window 2235 displays an image of thepatient tissue T being stapled and a staple firing path 2243 along whichthe stapling instrument 2200 is moving. The staple firing path 2243 isdisplayed as a series of actuations, or staple firings, 2244. Eachprojected actuation 2244 shows the path in which the tissue T will beincised and the positions in which staple clusters 2245 will be deployedinto the tissue T relative to the tissue incision. The projectedactuation 2244 nearest to the distal head of the stapling instrument2200 is highlighted relative to the other projected actuations 2244 sothat the user can differentiate between the upcoming staple firing andsubsequent projected staple firings. Such highlighting can include adifferent color and/or brightness of color, for example, of theprojected actuation 2244. In at least one instance, the displayedactuations 2244 of the staple firing path 2243 can be progressively lessintense as they move away from the distal head of the staplinginstrument 2200.

Further to the above, the display 2230 is further configured to displayone or more alternative staple firing paths. For instance, the display2230 is configured to display an alternative staple firing path 2243′ inthe center image window 2235. Similar to the staple firing path 2243,the staple firing path 2243′ is displayed as a series of actuations, orstaple firings, 2244′. Each projected actuation 2244′ shows the path inwhich the tissue T will be cut and the positions in which the stapleclusters 2245 will be deployed in the tissue T. The menu 2231 comprisesa staple line control 2240 which can be actuated by the user of thestapling instrument 2200 to edit the staple firing path 2243 to createthe alternate staple firing path 2243′. Once the alternate staple firingpath 2243′ has been established, it can be saved and the staplinginstrument 2200 can be operated to follow the alternate staple firingpath 2243′. As illustrated in FIG. 20, the staple line control 2240comprises an actuatable edit sub-control 2241 and an actuatable savesub-control 2242 to modify and save the staple firing path as describedabove.

As described above, the staple firing path 2243 is modifiable into analternate staple firing path 2243′. The staple firing path 2243 and thealternate staple firing path 2243′ are displayed in an image whichoverlays the video image from the camera. The staple firing path 2243and the alternate staple firing path 2243′ are displayed in the sameimage overlay, or layer, but could be displayed in different imageoverlays, or layers. In at least one such instance, the staple firingpath 2243 is displayed in a first image overlay, or layer, and thealternate staple firing path 2243 is displayed in a second imageoverlay, or layer, which is different than the first image overlay. Thescreen of the display 2230 is configured to receive an input commandfrom the center image window 2235 which can drag the staple firing path2243 and/or the alternate staple firing path 2243′ within the imageoverlay, or overlays. The screen of the display 2230 is configured to beresponsive to the finger of the user such that the staple firing pathcan be modified by the user dragging their finger. Referring to FIG. 21,the screen of the display 2230 is further configured to be responsive toa stylus 2220, for example.

As discussed above, the display 2230 can be configured to display thecurrent, or intended, staple firing path and one or more alternatestaple firing paths. The controller of the stapling instrument 2200 isconfigured to generate one or more alternate staple firing paths anddisplay these alternate staple firing paths on the display 2230. Invarious instances, the controller can determine the alternate staplefiring paths based on one or more attributes of the tissue T beingstapled. For instance, the controller can identify blood vessels withinthe tissue T and provide, or offer, an alternate staple firing pathwhich steers the stapling instrument 2200 around the blood vessels.

Referring to FIG. 22, the display 2230 comprises a menu including aplurality of controls which are configured to modify the staple firingpath while the stapling instrument 2200 is deploying the staple pathand/or after the stapling instrument 2200 has been stopped. The display2230 comprises a menu 2231 including a plurality of actuatable controlswhich are configured to be used while the stapling instrument 2200 isperforming its series of staple firing strokes to create the staplepath. The menu 2231 comprises a view control 2232 to change the videoimage displayed in the center image window 2235, for example. In atleast one such instance, the video control can be used to toggle betweendifferent video feeds. The menu 2231 further comprises the staple line2240 control, discussed above, which is configured to modify the staplefiring path. The staple firing system of the stapling instrument 2200can be started by the user actuating a stapling control 2234 in the menu2231 and stopped by the user actuating a stop control 2236 in the menu2231.

Further to the above, the shaft assembly attached to the handle of thestapling instrument 2200 can be rotated relative to the handle. Theshaft assembly includes a rotatable slip joint configured to permit thedistal head of the shaft assembly to rotate relative to the handle,although any suitable arrangement can be used. As a result of this slipjoint, the user of the stapling instrument 2200 can selectively orientthe display 2230 relative to the distal head of the stapling instrument2200. In such instances, the user can maintain the orientation of thedisplay 2230 with respect to the patient, for example, even though thedistal head is turning to follow the staple firing path. Similarly,FIGS. 144-146 depict the stapling instrument 1000 inserted into apatient P through a trocar TC and, owing to a rotatable interfacebetween the handle display and shaft assembly of the stapling instrument1000, the handle display can be maintained by the clinician C in aconstant orientation relative to themselves even though the shaftassembly is rotating to follow the staple firing path FP.

Referring to FIGS. 147-150, a stapling instrument 7000 comprises ahandle 7010 including a grip 7020 and a shaft assembly 1200 assembled tothe handle 7010. The handle 7010 further comprises a display 7030rotatably attached to the handle 7010 about a rotation joint 7035. Thedisplay 7030 is similar to the display 2230 in many respects, most ofwhich will not be discussed herein for the sake of brevity. In use, thedisplay 7030 can be rotated relative to the handle 7010 to maintain asuitable orientation of the display 7030 relative to the clinician Cand/or any other frame of reference.

FIG. 180 depicts a handle 1500 of a surgical instrument 100 for use by aclinician during a surgical procedure. The handle 1500 comprises acentral portion 110 bordered by one or more ergonomic grips 120 tofacilitate handling of the surgical instrument 100 by the clinician.Each ergonomic grip 120 is configured to fit within a hand of theclinician for enhanced control and comfort. The handle 1500 comprisesone or more interactive controls 180 configured to provide navigationcommands to an end effector of the surgical instrument 100. In variousinstances, one or more interactive controls 180 are configured toprovide a user command corresponding to a selection of one or moreitems. The interactive controls 180 are positioned on the handle 1500 ina location that allows for easy operation by the clinician, such as in alocation within reaching distance of a clinician's thumb. In variousinstances, the controls 180 are comprised of various types of switchesand/or buttons, for example. In various instances, the interactivecontrols 180 comprise a toggle switch, an analog stick, a rocker, aD-pad, and/or any other suitable interactive control capable offacilitating the communication of a user command to the controller ofthe surgical instrument 100, for example.

The handle 1500 further comprises a touch-sensitive display 1510. Aportion of the touch-sensitive display 1510 displays a menu bar 1512 tothe clinician. The options of the menu bar 1512 represent variousdisplay modes of the surgical instrument 100 including, but not limitedto, a view mode, a position mode, and/or a staple mode. In the variousdisplay modes, data and/or images relevant to the surgical procedureand/or the status of surgical instrument 100 are displayed. In the viewmode, the touch-sensitive display 1510 displays a plurality of views ofthe surgical site, including, for example, a side view and a top view.The side view and the top view are displayed in separate frames 1514,1516 of the touch-sensitive display 1510, although they could bedisplayed in any suitable manner. The clinician is able to focus on aparticular view by switching the desired view into an enlarged,centralized frame 1518 using the interactive controls 180, as describedabove. In various embodiments, the clinician can switch between views bydragging the desired view toward the central frame 1518 with an inputdevice 1530, such as a stylus or a finger of the clinician, for example.The input device 1530 is described in greater detail below.

In order to create a sterile environment for the surgical instrument100, a sterile barrier 190 is draped over the handle 1500, as seen inFIG. 181. As will be discussed in greater detail below, the sterilebarrier 190 is comprised of a clear, elastic material, such as plastic,for example. The sterile barrier 190 extends around the handle 1500 andonto a proximal portion of the shaft 200. The sterile barrier 190comprises one or more pre-molded areas 192 configured to fit over theinteractive controls 180. The pre-molded areas 192 assist in aligningthe sterile barrier 190 over the handle 1500 of the surgical instrument100. The sterile barrier 190 is stretched over the touch-sensitivedisplay 1510 to create a smooth, uniform barrier, or an at leastsubstantially smooth, uniform barrier. Attachment members 194, such asclips, for example, secure the sterile barrier 190 in position around aperimeter 193 of the touch-sensitive display 1510. The sterile barrier190 fits loosely around the remaining components of the handle 1500, andthe sterile barrier 190 is cinched around the shaft 200 of the surgicalinstrument 100, although any suitable arrangement can be used. Coveringthe handle 1500 with the sterile barrier 190 protects various componentsof the handle 1500 from exposure to bodily fluids and/or contaminants,for example. Draping the sterile barrier 190 over the handle 1500 andthe proximal portion of the shaft 200 also provides a cost-effective andrapid means for the handle 1500 of the surgical instrument 100 to besterilized and reused.

FIG. 182 depicts a touch-sensitive display assembly 500. Thetouch-sensitive display assembly 500 comprises a sterile barrier 190 anda touch-sensitive display 1510. In certain instances, thetouch-sensitive display 1510 acts as a projected capacitive sensor. Thetouch-sensitive display 1510 comprises an insulative layer 1511comprised of an insulative material mounted on top of a sensingmechanism 1513. In certain instances, the insulative layer 1511 ismounted to the sensing mechanism 1513 by a bonding adhesive, such as anoptical bonding adhesive, for example. As discussed above, the sterilebarrier 190 is stretched over the touch-sensitive display 1510 in auniform, or nearly uniform, fashion. Attachment members 194 (FIG. 181)retain the sterile barrier 190 in its stretched position in a mannerthat creates a gap 1520 in between the sterile barrier 190 and theinsulative layer 1511. The gap 1520 spans a distance of a fewmillimeters between the insulative layer 1511 and the sterile barrier190, and the gap 1520 is configured to prevent the formation of contactbubbles should the sterile barrier 190 come into contact with theinsulative layer 1511.

Conductive particles 191 are dispersed throughout the sterile barrier190, giving the sterile barrier 190 a particular capacitance. Thesensing mechanism 1513 of the touch-sensitive display assembly 500comprises a plurality of pixels 1515 and a material, such as indium tinoxide, for example, configured to create electrodes. In variousinstances, as discussed in more detail with respect to FIG. 183, theelectrodes are arranged in an orthogonal grid, although any suitablearrangement can be used. Among other things, the sensing mechanism 1513is configured to detect when the sterile barrier 190 is attached. Morespecifically, the sensing mechanism 1513 detects attachment of thesterile barrier 190 by the particular capacitance of the sterile barrier190. When a clinician wants to utilize the functionality of thetouch-sensitive display 1510, the input device 1530, as mentioned above,is brought into contact with the sterile barrier 190 at a desiredcontact point. The sensing mechanism 1513 is configured to detect theadditional capacitance of the input device 1530 and differentiate thecapacitance of the input device 1530 from the capacitance of the sterilebarrier 190. Moreover, as the input device 1530 is brought into contactwith the sterile barrier 190, the conductive particles 191 of thesterile barrier 190 are compressed, or brought closer together. Suchcompression creates a higher density of conductive particles 191 in thearea surrounding the contact point of the input device 1530, and thus, ahigher capacitance. Pixels 1515 of the sensing mechanism 1513 becomeactivated or energized in the vicinity of the contact point due to thechange in electrical charge at the contact point in the sensingmechanism 1513.

The touch-sensitive display 1510 is configured to function in the sameand/or similar manner without the sterile barrier 190. In certaininstances, the input device 1530 is comprised of a finger of theclinician enclosed by a latex glove, for example. Medical latex glovesare typically thin enough so as not to impede the conductive qualitiesof a clinician's finger. In instances where a glove worn by theclinician is expected to dampen the conductive qualities of theclinician's finger, settings of the touch-sensitive display 1510 can bealtered to increase sensitivity of the sensing mechanism 1513.

FIG. 183 depicts the touch-sensitive display 1510 of FIG. 182 when aninput device 1530 contacts the sterile barrier 190 of thetouch-sensitive display assembly 500. As mentioned above, in variousinstances, the electrodes are arranged in an orthogonal grid, althoughany suitable arrangement can be used. In such instances, the electrodescomprise x-electrodes 1542 and y-electrodes 1544. The touch-sensitivedisplay 1510 comprises a plurality of pixels 1515 arranged in a uniform,or nearly uniform, fashion throughout the sensing mechanism 1513,although any suitable arrangement can be used. FIG. 183 further depictsvarious groupings of activated pixel clusters 1517 and 1519. During itsunactivated state, a low-level capacitance is present across all of thepixels 1515 (FIG. 182) in the touch-sensitive display 1510. When theinput member 1530 (FIG. 182) contacts the sterile barrier 190 andactivates the touch-sensitive display 1510, the pixels 1515 associatedwith pixel clusters 1517 and 1519 are activated with a new, highercapacitance. The pixels 1515 in the pixel clusters 1517 and 1519 becomeactivated as the input device 1530 continues to make contact with thesterile barrier 190. The sensing mechanism 1513 detects the location ofthe active pixel clusters 1517, 1519 by scanning the matrix ofx-electrodes 1542 and y-electrodes 1544.

FIG. 184 depicts a graphical representation 1550 of the relationshipbetween the location of active pixel clusters within the x-electrodes1542 of the touch-sensitive display 1510 and the detected capacitance bythe sensing mechanism 1513. A first capacitance C₁ is indicative of thelow-level, or unactivated, capacitance present across the pixels 1515 ofthe touch-sensitive display 1510 prior to application of the sterilebarrier 190. By way of reference, capacitance C₀ represents a detectedcapacitance of zero, and capacitance C₁ represents a capacitance of morethan zero. A second capacitance C₂ is indicative of a thresholdcapacitance. When the threshold capacitance C₂ is exceeded, the surgicalinstrument 100 recognizes that the sterile barrier 190 is attached tothe touch-sensitive display 1510. In the graphical representation 1550,the sterile barrier 190 is attached to the touch-sensitive display 1510,as the detected capacitance is above the threshold capacitance C₂. Athird capacitance C₃ represents another threshold capacitance. When thesensing mechanism 1513 detects a capacitance that is greater than thethreshold capacitance C₃, the surgical instrument 100 recognizes thatthe input device 1530 is in contact with the sterile barrier 190. In thegraphical representation 1550, the input device 1530 is in contact withthe sterile barrier 190 in two locations, as the detected capacitanceexceeds the threshold capacitance C₃ twice. When the input device 1530is removed from the sterile barrier 190, the capacitance detected by thepixels 1515 in clusters 1517 and 1519 returns to the capacitance tobelow C₃, but above or equal to C₂. When the sterile barrier 190 isremoved from the touch-sensitive display 1510, the capacitance detectedby the pixels 1515 in clusters 1517 and 1517 returns to the capacitanceto below C₂, but above or equal to C₁.

Returning to FIG. 182, the touch-sensitive display 1510 is alternativelya resistance-sensitive display. In at least one such embodiment, thesterile barrier 190 is comprised of a flexible material to allow thesterile barrier 190 to deflect in response to a force F applied by theinput device 1530. In such an embodiment, the sensing mechanism 1513 ofthe touch-sensitive display 1510 is configured to detect the locationand pressure created from the force F applied by the input device 1530.Various user commands are associated with specific locations on thetouch-sensitive display 1510, and the location of the detected pressurewill correspond with one of the various user commands.

Referring to FIG. 24, a surgical instrument 2400 comprises a display2430. The stapling instrument 2400 is similar to the staplinginstruments 2000 and 2200 in many respects and the display 2430 issimilar to the displays 2130 and 2230 in many respects, most of whichwill not be discussed herein for the sake of brevity. The display 2430comprises a touchscreen including an image display 2435. The imagedisplay 2435 provides an image of the patient tissue T that is to bestapled. The user of the stapling instrument 2400 can use a stylus 2220,for example, to draw one or more potential staple lines over the tissueT. For instance, the user can draw a first staple line 2444 and a secondstaple line 2444′. The controller of the stapling instrument 2400 canthen require the user to choose between the two different staple lines2444 and 2444′ that is to be followed. Similarly, the user of thestapling instrument 2400 can use the stylus to modify a staple line 2444into an alternate staple line 2444′.

Referring again to FIG. 24, the image of the tissue T can be asubstantially two-dimensional image of the top of the tissue T. In suchinstances, the controller is configured to map a two-dimensional staplefiring path over the tissue T. Referring to FIG. 25, the image of thetissue T can be a three-dimensional image looking over the surface ofthe tissue T. In such instances, the controller is configured to map athree-dimensional staple firing path over the tissue T. In either event,the stylus 2220 and/or the patient's finger can be used to establishand/or modify the staple firing path. Referring now to FIGS. 26 and 27,the stapling instrument 2400 further comprises a joystick 2450configured to modify the staple firing path 2444 of the staplinginstrument 2400. The joystick 2450 is mounted to the handle of thestapling instrument 2400 and is rotatable about an axis. When thejoystick 2450 is rotated to the right, or in a clockwise direction, thestaple firing path 2444 is curved to the right. Correspondingly, thestaple firing path 2444 is curved to the left when the joystick 2450 isrotated to the left, or in a counter-clockwise direction. Otherarrangements of a joystick are possible.

Referring again to FIGS. 26 and 27, the joystick 2450 can be used tomodify the staple firing path of the stapling instrument 2400 while thestapling instrument 2400 is paused, or not firing staples. The joystick2450 can also be used by the clinician to steer the stapling instrument2400 in real-time while the stapling instrument 2400 is firing staples.In various instances, at least a portion of the stapling instrument 2400is visible on the display 2430 to assist the user in steering thestapling instrument 2400. For instance, a shaft 2410 of the staplinginstrument 2400 is visible in the image display 2435. In variousinstances, a graphically-created depiction of the stapling instrument2400 can be provided in one or more windows of the display 2430. Forinstance, the shaft 2410 and/or distal head 2420 of the staplinginstrument 2400 can be depicted in the windows 2133 and 2134, forexample.

As described above, referring now to FIG. 23, the stapling instrument2100 comprises a handle 2110 including a grip 2120 and a display 2130mounted on the handle 2110. The display 2130 can comprise any suitableconfiguration, but the size of the display 2130 may be limited owing tothe space constraints of the handle 2110. In various instances, thestapling instrument 2100 can be part of a surgical system 2300 whichincludes an off-board display 2330 in addition to or in lieu of theon-board display 2130. The controller of the stapling instrument 2100 isin signal communication with the displays 2130 and 2330. The controlleris in wireless communication with the off-board display 2330, but couldbe in wired communication with the display 2330. In either event, thecontroller is configured to provide the same information to the displays2130 and 2330. That said, the displays 2130 and 2330 can be configuredto arrange this information in different ways owing to their differentsizes and/or shapes. In other instances, one of the displays 2130 and2330 can display more information than the other. In at least one suchinstance, the off-board display 2330 can display more information thanthe on-board display 2130 owing to its larger size, for example.

Further to the above, the on-board display 2130 comprises a touchscreen,but could be operated by controls positioned on the handle 2110.Similarly, the off-board display 2330 also comprises a touchscreen, butcould be operated by other controls. Similar to the above, thetouchscreens of the displays 2130 and 2330 can be used to manipulate thestaple firing path of the stapling instrument 2100. In variousinstances, a clinician can use their finger to touch the touchscreensand drag the staple firing path of the stapling instrument 2100 into anew position, for example. In other instances, a tool, such as a stylus,for example, can be used to touch the touchscreens and manipulate thestaple firing path. Moreover, both displays 2130 and 2330 are configuredto control any other operation of the stapling instrument 2100.

When a first overlay, or layer, is modified on one of the displays 2130and 2330, the controller of the stapling instrument 2100 modifies thefirst overlay on the other display. Similarly, when a second overlay, orlayer, is modified on one of the displays 2130 and 2330, the controllerof the stapling instrument 2100 modifies the second overlay on the otherdisplay. Moreover, the user of the stapling instrument 2100 can modifyone overlay, or layer, on a display without modifying the otheroverlays, or layers, on the display or either display.

While the staple firing paths, and/or other images, projected in theon-board and off-board displays described above are very helpful toproduce a desired staple firing path, a stapling instrument can includeone or more projectors configured to display an image onto the patienttissue which can assist the user of the stapling instrument withproducing a desired staple firing path. Referring to FIGS. 160 and 161,a stapling instrument 7400 comprises a shaft 7410, a distal head 7420,and a projector 7490 mounted to the distal head 7420. In at least oneinstance, the projector 7490 is clamped to the distal head 7420. Theprojector 7490 is configured to project an image I onto the stomach S ofthe patient P. The projector 7490 is sized and configured to be insertedinto the patient through a trocar TC, but could be inserted into apatient through an open incision. The projector 7490 is positionedproximally with respect to an anvil 7460 of the distal head 7420, butdistally with respect to an articulation joint rotatably connecting thedistal head 7420 to the shaft 7410. As a result, the projector 7490, andthe image it projects, moves with the distal head 7420.

Referring to FIG. 162, a stapling instrument 7500 comprises a shaft7510, a distal head 7520, and an articulation joint 7570 rotatablyconnecting the distal head 7520 to the shaft 7510. The staplinginstrument 7500 further comprises a projector 7590 extending alongsidethe shaft 7510. The projector 7590 comprises a flexible tube mounted tothe shaft 7510 and the distal head 7520 and is configured to bend whenthe distal head 7520 is articulated. As a result, the image I projectedby the projector 7590 tracks the orientation of the distal head 7520 andcan be projected distally with respect to an anvil 7560 of the staplinginstrument 7500. The projector 7590 comprises one lens and is configuredto project one image I; however, various alternative embodiments areenvisioned in which a projector comprises more than one lens and/or canproject more than one image onto the patient tissue.

Referring again to FIG. 160, the projector 7490 comprises a first lens7492 and a second lens 7494. The first lens 7492 and the second lens7494 are in signal communication with the controller of the staplinginstrument 7400 and are configured to project at least one image ontothe patient tissue. In certain instances, the first lens 7492 and thesecond lens 7494 project the same image. The first lens 7492 and thesecond lens 7494 are fixedly mounted in the projector 7490 such thatthey project the image at a common focal point, although they couldproject an image, or images, at different focal points. In variousembodiments, the orientation of the first lens 7492 and/or theorientation of the second lens 7494 can be adjusted to alter the focalpoint. In at least one such embodiment, the projector 7490 comprises afirst motorized actuator system for changing the orientation of thefirst lens 7492 and a second motorized actuator system for changing theorientation of the second lens 7494.

In certain instances, further to the above, the first lens 7492 of theprojector 7490 can be configured to project a first image onto thepatient tissue and the second lens 7494 can be configured to project asecond, or different, image onto the patient tissue. The controller ofthe stapling instrument 7400 is configured to supply, change, and/oralter the image projected by the first lens 7492 and/or the second lens7494. In various instances, the images projected by the first lens 7492and the second lens 7494 can provide a two-dimensional image on thepatient tissue. In other instances, the images projected by the firstlens 7492 and the second lens 7494 can provide a three-dimensional imageon the patient tissue. Projecting a three-dimensional image can befacilitated by the lenses 7492 and 7494 being oriented, or orientable,in different directions.

Referring to FIG. 165, a stapling instrument 7700 comprises a distalhead 7720 positioned on a first side of the patient tissue T and ananvil 7760 positioned on a second side of the patient tissue T. Similarto the other stapling instruments disclosed herein, the staplinginstrument 7700 is configured to deploy staples 7730 into the tissue Tand incise the tissue T along an incision 7740 during a series of staplefiring strokes. The stapling instrument 7700 further comprises aprojector 7770 configured to project an image I onto the tissue T. Theimage I in FIG. 165 represents the location of the next firing strokeincluding two lateral areas in which staple clusters will be applied.Referring to FIG. 166, an image projected by the projector 7770comprises a line designating the staple firing path FP and/or a linedesignating an alternate staple firing path FP′. These lines can besolid lines and/or dashed lines, for example. The lines can be the samecolor or different colors.

Further to the above, the controller of the stapling instrument 7700 isconfigured to modify the image projected by the projector 7770 as thestapling instrument 7700 moves, or marches, along a staple firing path.The controller can continuously evaluate and determine where the nextfiring stroke should occur and also continuously adapt the imageprojected by the stapling instrument 7700. In various instances, thecontroller can update the projected image after each firing stroke, forexample. In some instances, the controller can continuously project animage, or a series of images, using the projector 7770 while, in otherinstances, the controller can intermittently project an image, or aseries of images, using the projector 7770. In at least one instance,the controller can use the projector 7770 to display an image before thestapling instrument 7700 clamps the tissue. In such instances, the userof the stapling instrument 7700 is afforded an opportunity to pause orstop the stapling instrument 7700 before it makes another staple firingstroke.

Referring to FIG. 167, a stapling instrument 7800 comprises a distalhead 7820 positioned on a first side of the patient tissue T and ananvil 7860 positioned on a second side of the patient tissue T. Similarto the other stapling instruments disclosed herein, the staplinginstrument 7800 is configured to deploy staples 7830 into the tissue Tand incise the tissue T along an incision 7840 during a series of staplefiring strokes. The stapling instrument 7800 further comprises aprojector 7870 including a first lens 7872 and a second lens 7874. Thefirst lens 7872 is configured to project a first image I₁ onto thepatient tissue T and the second lens 7874 is configured to project asecond image I₂ on the patient tissue T. The image I₁ depicts thelocations of the next staple clusters and the image I₂ depicts thecutting path of the stapling instrument 7800, although any suitableimages could be projected. The images I₁ and I₂ can be solid linesand/or dashed lines, for example. The image I₁ can be the same color asthe image I₂ or a different color.

As discussed above, the stapling instruments disclosed herein cancomprise at least one projector for projecting images onto the patienttissue and at least one camera for observing the patient tissue.Referring to FIGS. 163 and 164, a stapling instrument 7600 comprises ashaft, a distal head, and a video system. The video system comprises atleast one image projector 7690 and a camera system 7670 comprising atleast one camera, such as a first camera 7672 and a second camera 7674,for example, which are in communication with the controller. The firstcamera 7672 is pointed in a first direction and is focused on a firstarea F1 of the patient tissue and the second camera 7674 is pointed in asecond direction and is focused on a second, or different, area F2 ofthe patient tissue. In various instances, the controller is configuredto present both images on the surgical instrument display at the sametime, or at different times such that the user can toggle between theimages. In certain instances, the controller is configured to use theimages from the first and second cameras 7672 and 7674 to generate acomposite image and present the composite image on the surgicalinstrument display.

Further to the above, the first camera 7672 comprises a digital cameraconfigured to supply a first digital video stream to the controllerwhile the second camera 7674 comprises a digital camera configured tosupply a second digital video stream. The camera system 7670 furthercomprises a first actuator system configured to move the first camera7672 and/or a second actuator system configured to move the secondcamera 7674. In other embodiments, one or both of the orientations ofthe cameras 7672 and 7674 are fixed. In any event, the image I projectedonto the patient tissue by the projector 7690 can be captured by thefirst camera 7672 and/or the second camera 7674 and is viewable by theuser of the surgical instrument 7600 through the surgical instrumentdisplay.

Further to the above, the projector 7690, and/or any of the projectorsdisclosed herein, are configured to emit light at any suitablewavelength. In various instances, the projector 7690 emits visiblelight, infrared light, and/or ultraviolet light, for example. Amongother things, visible light is useful for the clinician to see the colorof the tissue when the visible light reflects off the tissue. Red orpink tissue indicates healthy, vascularized tissue while dark or blacktissue may indicate unhealthy tissue. Also further to the above, thecamera system 7670 is configured to capture visible light, infraredlight, and/or ultraviolet light, for example. Infrared light indicatesthe presence of heat, such as from large blood vessels, for example.Ultraviolet light indicates the presence of blood, or bleeding, forexample. In addition to or in lieu of the above, a projector can beconfigured to emit sound waves, subsonic waves, and/or ultrasonic wavesand the surgical instrument can comprise one or more acoustic sensorsconfigured to detect the waves which reflect off of the patient tissueand generate data which can be used by the controller to generate athree-dimensional profile of the patient tissue.

Referring to FIG. 142, the stapling instruments described herein areconfigured to repeatedly fire staples into the tissue of a patient, suchas the patient's stomach S, for example. Many of the staplinginstruments disclosed herein are self-driving, self-propelled, and/orself-steering in that they are sufficiently motorized such that they canfollow and propel themselves along an intended, or modified, staplefiring path FP while firing staples, such as staples 6630, for example,into the patient tissue. The staples are continuously ejected from thestapling instruments as the stapling instruments move along the staplefiring path FP. In various instances, the staple firing system of astapling instrument enters into a dwell between staple firing strokeswhile the stapling instrument is moved along the staple firing path.Such dwells, however, are part of the continuous operation of thestapling instrument. As discussed above, referring to FIG. 143, many ofthe stapling instruments described herein are configured to deploy acluster of staples, such as staple clusters 6630′, for example, duringeach staple firing stroke. Such staple clusters can include any suitablenumber of staples, but each of the staple clusters 6630′ depicted inFIG. 143 comprise three staples 6630 and are deployed on both sides of atissue incision 6640. In at least one exemplary embodiment, seven stapleclusters 6630′ are deployed on each side of the tissue incision 6640 foreach inch of the staple firing path. In such embodiments, 42 staples aredeployed per inch, although any suitable number can be used. Thestapling instrument can continue to deploy staples along the staplefiring path without having to remove the stapling instrument from thepatient so long as there are staples in the stapling instrument. In atleast one instance, a stapling instrument can be used between 84 and 98firings, for example, before having to be reloaded. Such firings candeploy between 504 and 588 staples, for example.

Further to the above, many of the stapling instruments disclosed hereincan at least partially turn between staple firings. As a result, suchstapling instruments can follow complex and/or non-linear staple firingpaths. Referring to FIG. 174, previous stapling instruments wereconfigured to deploy linear staple line portions 8230′ comprised ofstaples 8230, for example. In order to turn the staple line within thetissue, an overlap region 8235′ in staple line portions 8230′ wascreated. Such an arrangement created a high density of staples 8230 inthe overlap region 8235′, thereby highly compressing the tissue in theoverlap region 8235′. Moreover, the overlap region 8235′ represents asharp turn in the staple firing path, which could create potential leakpaths in the staple line. Referring to FIG. 175, the staplinginstruments disclosed herein can make much more gradual turns becausethey can turn after each firing stroke. For instance, a staplinginstrument can turn after deploying each staple cluster 7930′ and can doso without creating overlap between the staple clusters 7930′.

The stapling instruments disclosed herein can be used to perform anysuitable surgical procedure. For instance, referring to FIG. 179, astapling instrument disclosed herein can be used during a gastric bypassprocedure to produce a stomach pocket SP and, thus, effectively reducethe size of the patient's stomach S. Owing to the systems of thestapling instruments disclosed herein, these stapling instruments cancreate a curved staple path 7930′ which creates a curved stomach pocketSP. Previous stapling instruments, referring to FIG. 178, would generatea staple path including linear portions 8230′ which formed a squarestomach pocket SP, or a stomach pocket SP with a right angle corner. Itis believed that the curved stomach pocket SP produced by the staplinginstruments disclosed herein will leak less than the linear stomachpockets SP produced by previous stapling instruments.

As described in greater detail herein, referring to FIG. 177, thestapling instruments disclosed herein can be used during a stomachreduction procedure to produce a stomach sleeve SS and, thus,effectively reduce the size of the patient's stomach S. Owing to thesystems of the stapling instruments disclosed herein, these staplinginstruments can create a curved staple path 7930′ which creates a curvedstomach sleeve SS. Previous stapling instruments, referring to FIG. 176,would generate a staple path including linear portions 8230′ whichformed a linear stomach sleeve SS, or a stomach sleeve SS with a rightangle corner 8235′. It is believed that the curved stomach sleeve SSproduced by the stapling instruments disclosed herein will leak lessthan the linear stomach sleeves SS produced by previous staplinginstruments. Additional details for creating a stomach sleeve SS areillustrated in FIG. 151 wherein a staple firing path FP is used to cutthe stomach sleeve SS from the patient's stomach S.

Further to the above, gastric bypass procedures and gastric sleeveprocedures aid in weight loss and are used to treat severe obesity. Bothprocedures serve to drastically decrease the size of the stomach inorder to limit food intake. Gastric bypass procedures involve creating asmall section within the stomach for receiving food and blocking off therest of the stomach. Among other things, restricting the size of thestomach serves to limit the amount of fat and calories absorbed into apatient's body. Gastric bypass procedures create a direct path from thesmall stomach section to the lower intestine. In such instances, as aresult, this direct path eliminates the use of the upper intestine indigestion.

A gastric sleeve procedure involves creating a sleeve-like path from theesophagus, through the stomach, and to the upper intestine. Laparoscopicsleeve gastrectomy (LSG) is a type of gastric sleeve procedure whichinvolves the transection and sealing off of a substantial portion of thestomach in order to create a small gastric reservoir, or pocket. Unlikea gastric bypass procedure, it has been found that a LSG procedure doesnot cause a decrease in the absorption of nutrients and/or eliminate theuse of any portion of the intestines. A LSG procedure, however, stillfunctions to significantly reduce the size of the stomach in a patient.In such LSG procedures, a long, thin, and flexible member, i.e., abougie, can be used as a measuring tool. More specifically, a bougie canbe used to determine or define the size and shape of the stomach thatbecomes the gastric sleeve upon completion of the LSG procedure. Abougie B is depicted in FIGS. 30 and 32. Bougies are manufactured in avariety of sizes in order to accommodate different stomach sizes. Theappropriate size of a bougie is often determined based on stomach sizeand the anticipated gastric sleeve size. During the beginning steps of aLSG procedure, a surgeon inserts the bougie through a patient's mouth,down the esophagus, and through the esophageal sphincter to ultimatelyreach the patient's stomach. Once the bougie reaches the patient'sstomach, the bougie is placed so that the end of the bougie reaches thepyloric canal, which is the lower area of the stomach connected to thepylorus.

FIG. 28 illustrates various parts of the stomach anatomy involved duringvarious steps of a LSG procedure. In particular, FIG. 28 illustrates thestomach before a bougie B is inserted into the stomach S during a LSGprocedure. As seen in FIG. 28, the omentum O, which is a double layer offatty tissue, is connected to the outer layer of the stomach S. Theomentum O comprises two portions—the greater omentum and the lesseromentum. The greater omentum serves to store fat deposits and the lesseromentum connects the stomach S and the intestines to the liver. Thestomach S comprises various areas of shadowing based on the tissuethickness of the stomach S. The tissue thickness of the stomach Screates a first shadow S_(1a) and a second shadow S_(1b). The size andlocation of the shadows S_(1a) and S_(1b) vary based on the thickness ofthe stomach S. As further illustrated in FIG. 28, the first shadowS_(1a) appears along the greater curvature GC of the stomach S and thesecond shadow S_(1b) appears along the lesser curvature LC of thestomach S. As discussed in greater detail below, the shadows S_(1a) andS_(1b) are used to determine, or estimate, the thickness of the stomachS along the greater curvature GC and the lesser curvature LC,respectively. Once the thickness of the stomach S is determined, orestimate, it is used to determine the appropriate size and placement ofthe bougie B in relation to the calculated shading lines S_(L) as seenin FIG. 28.

FIG. 33 illustrates another view of the stomach anatomy in accordancewith various embodiments. Similar to the stomach anatomy depicted inFIG. 28, the tissue thickness of the stomach S creates a first shadow S₁and a second shadow S₂. Similar to the discussion above, the firstshadow S₁ occurs along the greater curvature GC and the second shadow S₂occurs along the lesser curvature LC. The first shadow S₁ and the secondshadow S₂ intersect at a point S₃. During a stomach sleeve procedure,the location of the pylorus P_(x) and the point S₃ are used to determinethe location of the cut line C¹ which is offset from the pylorus P_(x)at a distance A. As illustrated in FIG. 33 and described in greaterdetail below, the sleeve diameter D is determined based on the estimatedtissue thickness.

FIG. 152 illustrates various parts of the stomach which are involvedduring various steps of a LSG procedure. In particular, FIG. 152illustrates the early steps of a LSG procedure wherein a bougie B isinserted into the stomach S. At the beginning of the LSG procedure, asurgeon inserts the bougie B through a patient's mouth, down theesophagus E, and through the esophageal sphincter to ultimately reachthe patient's stomach. Once the bougie B reaches the patient's stomach,the bougie B is positioned so that the end of the bougie B rests in thepyloric canal PC and stops at the pyloric sphincter PS. As alsoillustrated in FIG. 152, the bougie B is configured to sit along theshape and length of the stomach S along the angular notch AN of thelesser curvature LC. As will be described in greater detail below withrespect to FIG. 153, a bougie 7210 can be used which comprises magneticproperties which are configured to interact with and guide a staplinginstrument 7100 along a predetermined path alongside the bougie 7210.

Referring again to FIG. 152, a distance D¹ is measured along the pyloricantrum PA of the greater curvature GC once the bougie is placed in itsfinal position. The distance D¹ is used to determine the location of thepylorus P_(x) and is used to determine the location of the cut line C¹.The bougie 7210 illustrated in FIG. 153 creates one or more magneticfields which are used to guide the stapling instrument 7100 to thebougie 7210. Thereafter, referring to FIG. 154, the stapling instrument7100 follows the magnetic fields along a path adjacent to the bougie7210 in order to create the cut line C¹. As a result, the cut line C′extends upward through the patient's stomach S along the shape andcurvature of both the stomach S and the bougie 7210. The cut line C′then continues upward through the patient's stomach S along the pathadjacent to the bougie 7210 until reaching the Angle of His AH. As thecut line C¹ is established, the stapling instrument 7100 appliesstaples, such as staples 7130, for example, to the tissue along bothsides of the cut line C¹. The remaining portion of the stomach S stillin communication with the esophagus is substantially the size and shapeof the bougie 7210. A substantial portion of the stomach S, which beginsat the pyloric antrum PA and ends at the Angle of His AH, is eliminatedfrom involvement in the digestive process. The eliminated portion of thestomach S is shown in greater detail in FIG. 154 and includes thegreater curvature GC of the stomach S.

In some instances, a clinician can estimate an appropriate staple firingpath in the patient's stomach by observing certain anatomical markers onthe stomach and/or at other locations within the surgical site.Referring to FIG. 152, the stapling instruments disclosed herein, suchas the stapling instrument 7100, for example, are configured to senseanatomical markers within the patient to determine the appropriatestaple firing path. Further to the above, the stapling instrumentsdisclosed herein can comprise one or more cameras configured to sense,or detect, one or more anatomical markers and, also, a controllerconfigured to calculate a staple firing path based on the detectedanatomical markers. In at least one instance, the stapling instrument isconfigured to detect the lesser curve of the stomach and calculate astaple firing path in the stomach tissue which parallels, or at leastsubstantially parallels, the lesser curve. Other anatomical markers ofthe patient's stomach that can be detected and used to determine thestaple firing path include the angular notch, the esophageal sphincter,the angle of His, the pyloric sphincter, and/or the pyloric antrum, forexample.

As discussed above, the lesser curve of the stomach can be used todetermine the staple firing path. In various instances, however, thelesser curve is at least partially obscured by fat and/or connectivetissue. That said, the lesser curve, the lesser omentum, and any overlapbetween the lesser curve and the lesser omentum, for example, can bevisibly differentiated. More specifically, the uncovered stomach tissuehas a first color, the lesser omentum has a second color which isdifferent than the first color, and the overlap between the two has athird color which is different than the first color and the secondcolor. These colors are detectable by the stapling instruments todetermine an appropriate staple firing path. In certain instances, thecolor of the stomach tissue under the lesser omentum creates a shadowwhich is detectable by the stapling instrument. Other methods can beused to determine the appropriate location for the staple firing path.

Further to the above, a stomach sleeve SS created during a gastricbypass procedure must have a sufficiently large enough digestion passagedefined therein in order for food to pass there through. As a result,referring now to FIG. 29, the staple firing path through the patient'sstomach S must be sufficiently spaced from the lesser curve of thestomach to create a sufficient digestion passage D. The staplinginstruments disclosed herein can be configured to detect the lessercurve of the stomach and calculate a staple firing path, such as staplefiring path SP₁, for example, which is a distance X away from the edgeof the stomach S. In other instances, the stapling instruments disclosedherein can be configured to detect the lesser omentum LO which bordersthe lesser curve of the stomach and calculate the staple firing pathSP₁, for example, as a preset or predetermined distance X away from theedge of the stomach S.

As mentioned above, detecting the edge of the stomach S may bedifficult. In certain instances, the stapling instruments disclosedherein can comprise a camera system configured to observe the color ofthe stomach tissue and/or changes in the stomach tissue color in orderto determine the edge of the stomach S. In various instances, thestapling instruments disclosed herein can be configured to detect theedge of the stomach by evaluating the thickness of the stomach tissueand/or changes in the stomach tissue thickness. The tissue of apatient's stomach is typically thinner around the perimeter, or edge, ofthe stomach than in the middle of the stomach and it has been observedthat the color of stomach tissue is often a function of its thickness.Stated another way, the tissue around the perimeter of the stomach seemsto have a shadow, or darker, color owing to its thinner thickness. Thisshadow region S, is demarcated by distance Z₁ in FIG. 29. Distance Z₁also demarcates the transition from the thinner tissue to the fulltissue thickness region T₁ of the stomach S. In various instances, thesurgical instruments disclosed herein can be configured to determine thestaple firing path SP₁ by establishing the staple firing path SP₁ acertain distance away from the shadow region S₁, for example. In atleast one instance, the surgical instruments can establish the staplefiring path SP₁ a certain distance away from the midpoint between thelesser omentum LO and the edge of the shadow region S₁, for example.

Further to the above, the controller of the stapling instrumentsdisclosed herein can comprise an edge detection algorithm. The edgedetection algorithm is configured to sense a first light intensity at afirst location and a second light intensity at a second location on thestomach tissue. The edge detection algorithm is further configured tocalculate a first light intensity value for the first light intensityand a second light intensity value for the second light intensity andthen compare the first light intensity value to the second lightintensity value. The light intensity values can be on a scale between 1and 100 where lower values represent darker tissue and higher valuesrepresent lighter tissue, for example. The first location and the secondlocation establish a sample line along which additional samples can betaken to establish an intensity gradient. To this end, the edgedetection algorithm is further configured to sense a third lightintensity at a third location along the sample line, determine a thirdlight intensity value at the third location, and compare the third lightintensity value to the first light intensity value and the second lightintensity value. The first location, the second location, and the thirdlocation are sequentially located along the sample line and, if thealgorithm determines that the first light intensity value is larger thanthe second light intensity value and that the second light intensityvalue is larger than the third light intensity value, then the algorithmcan determine that a shadow gradient exists between the first locationand the third location and that the third location is closer to the edgeof the stomach tissue than the first location, for example. Thismethodology can be applied on a very large scale to map the shadowgradient and/or color gradient of the entire stomach tissue, or at leasta portion of the stomach tissue.

As discussed above, the thickness of the stomach tissue can affect thecolor or shadow of the stomach tissue. Thus, stomachs having thickertissue (FIG. 29) will typically have different colors and/or shadowsthan stomachs having thinner tissue (FIG. 31). The thinner tissue inFIG. 31 has a shadow region S₂ demarcated by distance Z₂. Distance Z₂also demarcates the transition from the thinner tissue to the fulltissue thickness region T₂ of the stomach S₂. In various instances, thesurgical instruments disclosed herein can be configured to determine thestaple firing path SP₂ by establishing the staple firing path SP₂ acertain distance away from the shadow region S₂, for example. In atleast one instance, the surgical instruments can establish the staplefiring path SP₂ a certain distance away from the midpoint between thelesser omentum LO₂ and the edge of the shadow region S₂, for example.

The staple firing path SP₁ establishes a first sleeve profile and thestaple firing path SP₂ establishes a second sleeve profile which isdifferent than the first sleeve profile. The first sleeve profilecomprises a first width X and the second sleeve profile comprises asecond width Y, which is different than the width X. Regardless of thesleeve profile that is generated by a stapling instrument disclosedherein, the tissue drive system of the stapling instrument is configuredto propel the stapling instrument along the staple firing path whichcreates the desired stomach sleeve. Such a stapling instrument can beconfigured to identify anatomical markers and steer itself toward, awayfrom, and/or parallel to one or more anatomical markers.

Further to the above, referring to FIG. 153, the stapling instrument7100 comprises a shaft 7110, a distal head 7120, and an articulationjoint 7170 rotatably connecting the distal head 7120 to the shaft 7110.The stapling instrument 7100 is incise the patient's stomach along apath C1 and apply three rows of staples 7130 on each side of the pathC1. As described above, the bougie 7210 is configured to guide thestapling instrument 7100 along a staple firing path. More specifically,the bougie 7210 is configured to emit one or more magnetic fields whichcan be detected by the stapling instrument 7100 and then used by thestapling instrument 7100 to determine the staple firing path. In atleast one instance, the bougie 7210 emits strong magnetic fields SMF andweak magnetic fields WMF which, when emitted, are emitted along thelength of the bougie 7210. Notably, the weak magnetic fields WMF arepositioned intermediate the strong magnetic fields SMF in an alternatingmanner.

Referring to FIG. 154, the stapling instrument 7100 comprises one ormore sensors, such as Hall Effect sensors, for example, which areconfigured to detect the strong magnetic fields SMF and the weakmagnetic fields WMF. The sensors are in communication with thecontroller of the stapling instrument 7100 which can use data from thesensors to detect the arrangement of the strong magnetic fields SMF andweak magnetic fields WMF and align the staple firing path with thefields SMF and WMF such that the stapling instrument 7100 follows thebougie 7210 to create the desired stomach sleeve profile. In at leastone instance, the intensity of the strong magnetic fields SMF is twiceas intense as the weak magnetic fields WMF, for example. In otherinstances, the intensity of the strong magnetic fields SMF is 50% moreintense than the intensity of the weak magnetic fields WMF, for example.

Referring to FIGS. 155 and 157, the bougie 7210 comprises an innerflexible core 7212 and a plurality of conductor windings configured toemit the magnetic fields SMF and WMF discussed above. The flexible core7212 is comprised of a non-conductive material, or an at leastsubstantially non-conductive material, such as rubber, for example. Theflexible core 7212 is solid, but could comprise a tube. The conductorwindings include winding circuits 7214 which emit the weak magneticfields WMF and winding circuits 7216 which emit the strong magneticfields SMF. The winding circuits 7214 have less windings than thewinding circuits 7216 and produce weaker magnetic fields than thewinding circuits 7216 for a given current. Each winding circuit 7214comprises a conductive wire that is wrapped around the inner flexiblecore 7212 and is in communication with a controller of the bougie 7210.Each winding circuit 7214 is separate and distinct from the otherwinding circuits 7214 and, moreover, separate and distinct from thewinding circuits 7216. Similarly, each winding circuit 7216 is separateand distinct from the other winding circuits 7216 and, moreover,separate and distinct from the winding circuits 7214. Each conductivewire comprises an inner conductive core and an insulative jacketextending around the conductive core. In an alternative embodiment, theconductive wires comprise conductive cores embedded in the flexible core7212. In either event, the bougie 7210 comprises an outer jacket 7218which is configured to seal the contents therein to prevent, or inhibit,the ingress of fluids into the bougie 7210.

In use, further to the above, a voltage source is applied to the windingcircuits 7214 and 7216. The voltage applied to each winding circuit 7214and 7216 is the same, or at least substantially the same. Alternatively,a first voltage is applied to the winding circuits 7214 and a second, ordifferent, voltage is applied to the winding circuits 7216. In variousalternative embodiments, the winding circuits 7214 are not separatecircuits; rather, they are part of one long circuit and a single currentflows through each of the winding circuits 7214. Similarly, in variousalternative embodiments, the winding circuits 7216 are not separatecircuits; rather, they are part of one long circuit and a single currentflows through each of the winding circuits 7216. In any event, thewinding circuits 7214 and 7216 emit magnetic fields which extend aroundthe entire perimeter of the bougie 7210 and, as a result, the bougie7210 can be oriented, or rotated, in any suitable manner to perform thesurgical procedure described above.

As described above, the bougie 7210 utilizes electricity to createmagnetic fields. In various alternative embodiments, a bougie cancomprise permanent magnets which create magnetic fields. In at least oneinstance, the bougie comprises strong permanent magnets which create astrong magnetic field and weak permanent magnets which create a weakmagnetic field. In at least one such instance, the strong permanentmagnets and the weak permanent magnets are arranged in an alternatingmanner to create the alternating strong magnetic fields SMF and weakmagnetic fields WMF depicted in FIG. 154, for example. That said, abougie can create one or more magnetic fields in any suitable manner.

Referring to FIG. 156, a bougie 7310 comprises an inner flexible core7312 and a plurality of conductor windings configured to emit themagnetic fields SMF and WMF discussed above. The flexible core 7312 iscomprised of a non-conductive material, or an at least substantiallynon-conductive material, such as rubber, for example. The conductorwindings include winding circuits 7314 which are configured to emit theweak magnetic fields WMF and winding circuits 7316 which are configuredto emit the strong magnetic fields SMF. The winding circuits 7314 haveless windings than the winding circuits 7316 and will produce weakermagnetic fields than the winding circuits 7316, for a given current.Each winding circuit 7314 comprises a conductive wire that is wrappedaround the inner flexible core 7312 and is in communication with acontroller of the bougie 7310. The windings of the circuits 7314 aremore compact, or dense, than the windings of the circuits 7214. Forinstance, the windings of the circuits 7214 extend longitudinally asthey wrap around the core 7212 while the windings of the circuits 7314do not extend longitudinally, or at least not substantially so.Similarly, the windings of the circuits 7316 are more compact, or dense,than the windings of the circuits 7216. Dense or compact windings cancreate dense or compact magnetic fields which may be more discernable tothe stapling instrument 7100, for example.

The surgical instrument systems described herein are motivated by anelectric motor; however, the surgical instrument systems describedherein can be motivated in any suitable manner. In certain instances,the motors disclosed herein may comprise a portion or portions of arobotically controlled system. U.S. patent application Ser. No.13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLEDEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535, for example,discloses several examples of a robotic surgical instrument system ingreater detail.

The surgical instrument systems described herein have been described inconnection with the deployment and deformation of staples; however, theembodiments described herein are not so limited. Various embodiments areenvisioned which deploy fasteners other than staples, such as clamps ortacks, for example. Moreover, various embodiments are envisioned whichutilize any suitable means for sealing tissue. For instance, an endeffector in accordance with various embodiments can comprise electrodesconfigured to heat and seal the tissue. Also, for instance, an endeffector in accordance with certain embodiments can apply vibrationalenergy to seal the tissue.

EXAMPLES Example 1

A surgical stapler for stapling the tissue of a patient comprising ahandle, a shaft extending from the handle, and an end effectorcomprising a tissue compression surface, and an anvil comprising stapleforming pockets, wherein the anvil is movable toward the tissuecompression surface during a closing motion. The surgical staplerfurther comprises an anvil closing system configured to move the anvilthrough the closing motion and a propulsion system comprising a firstfoot configured to engage the patient tissue and move the end effectorrelative to the patient tissue during a first propulsion stroke and asecond foot configured to engage the patient tissue and move the endeffector relative to the patient tissue during a second propulsionstroke.

Example 2

The surgical stapler of Example 1, wherein the propulsion system isconfigured to repetitively sequence the first propulsion stroke and thesecond propulsion stroke, whereby the propulsion system can walk the endeffector relative to the patient tissue.

Example 3

The surgical stapler of Examples 1 or 2, wherein the propulsion systemis configured to complete the first propulsion stroke before beginningthe second propulsion stroke.

Example 4

The surgical stapler of Examples 1, 2, or 3, wherein the propulsionsystem is configured to at least partially complete the first propulsionstroke before beginning the second propulsion stroke.

Example 5

The surgical stapler of Examples 1, 2, 3, or 4, wherein the propulsionsystem comprises means for synchronizing the first propulsion stroke andthe second propulsion stroke.

Example 6

The surgical stapler of Examples 1, 2, 3, 4, or 5, wherein the endeffector further comprises a staple cartridge comprising a plurality ofstaples.

Example 7

The surgical stapler of Example 6, further comprising a staple firingsystem configured to deploy the staples during a staple firing stroke.

Example 8

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, or 7, wherein thepropulsion system comprises synchronizing means for performing theclosing motion after the first propulsion stroke and the secondpropulsion stroke have both been performed.

Example 9

The surgical stapler of Example 8, wherein the synchronizing meansperforms the staple firing stroke after the closure stroke has beenperformed.

Example 10

The surgical stapler of Examples 8 or 9, wherein the synchronizing meansincludes a mechanism.

Example 11

The surgical stapler of Examples 8, 9, or 10, wherein the synchronizingmeans comprises a controller including a microprocessor.

Example 12

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11,wherein the propulsion system is configured to perform the firstpropulsion stroke and the second propulsion stroke at the same time.

Example 13

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or12, wherein the propulsion system is configured to perform the firstpropulsion stroke to steer the end effector in a first direction and thesecond propulsion stroke to steer the end effector in a seconddirection.

Example 14

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,or 13, further comprising a vacuum system in communication with at leastone of the first foot and the second foot, wherein the vacuum system isconfigured to hold the patient tissue within the end effector utilizingthe vacuum system.

Example 15

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, or 14, wherein the first foot comprises a first rotatable elementand the second foot comprises a second rotatable element.

Example 16

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, 14, or 15, wherein the first foot comprises a first set of teethconfigured to grip the patient tissue and the second foot comprises asecond set of teeth configured to grip the patient tissue.

Example 17

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, 14, 15, or 16, wherein the first foot comprises a first translatableelement and the second foot comprises a second translatable element.

Example 18

The surgical stapler of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, 14, 15, 16, or 17, wherein the first foot comprises a first base anda first extendable portion which is extendable relative to the firstbase, and wherein the second foot comprises a second base and a secondextendable portion which is extendable relative to the second base.

Example 19

A surgical stapler for stapling the tissue of a patient comprising ahandle, a shaft extending from the handle, and an end effectorcomprising a tissue compression surface and an anvil comprising stapleforming pockets, wherein the anvil is movable toward the tissuecompression surface during a closing motion. The surgical staplerfurther comprises an anvil closing system configured to move the anvilthrough the closing motion and a tissue advancement system comprising afoot configured to engage the patient tissue and pull the patient tissuerelative to the end effector during a tissue advancement stroke.

Example 20

A surgical stapler for stapling the tissue of a patient comprising ahandle, a shaft extending from the handle, a plurality of staplecartridges, and an end effector comprising a tissue compression surfaceand an anvil comprising staple forming pockets, wherein the anvil ismovable toward the tissue compression surface during a closing motion.The surgical stapler further comprises an anvil closing systemconfigured to move the anvil through the closing motion, a staple firingsystem configured to deploy the staple cartridges along a path, andmeans for gripping the patient tissue and creating relative movementbetween the end effector and the patient tissue to re-position the endeffector along the path.

The entire disclosures of:

U.S. Pat. No. 5,403,312, entitled ELECTROSURGICAL HEMOSTATIC DEVICE,which issued on Apr. 4, 1995;

U.S. Pat. No. 7,000,818, entitled SURGICAL STAPLING INSTRUMENT HAVINGSEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, which issued on Feb. 21,2006;

U.S. Pat. No. 7,422,139, entitled MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK, which issued onSep. 9, 2008;

U.S. Pat. No. 7,464,849, entitled ELECTRO-MECHANICAL SURGICAL INSTRUMENTWITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS, which issued on Dec.16, 2008;

U.S. Pat. No. 7,670,334, entitled SURGICAL INSTRUMENT HAVING ANARTICULATING END EFFECTOR, which issued on Mar. 2, 2010;

U.S. Pat. No. 7,753,245, entitled SURGICAL STAPLING INSTRUMENTS, whichissued on Jul. 13, 2010;

U.S. Pat. No. 8,393,514, entitled SELECTIVELY ORIENTABLE IMPLANTABLEFASTENER CARTRIDGE, which issued on Mar. 12, 2013;

U.S. patent application Ser. No. 11/343,803, entitled SURGICALINSTRUMENT HAVING RECORDING CAPABILITIES, now U.S. Pat. No. 7,845,537;

U.S. patent application Ser. No. 12/031,573, entitled SURGICAL CUTTINGAND FASTENING INSTRUMENT HAVING RF ELECTRODES, filed Feb. 14, 2008;

U.S. patent application Ser. No. 12/031,873, entitled END EFFECTORS FORA SURGICAL CUTTING AND STAPLING INSTRUMENT, filed Feb. 15, 2008, nowU.S. Pat. No. 7,980,443;

U.S. patent application Ser. No. 12/235,782, entitled MOTOR-DRIVENSURGICAL CUTTING INSTRUMENT, now U.S. Pat. No. 8,210,411;

U.S. patent application Ser. No. 12/249,117, entitled POWERED SURGICALCUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM,now U.S. Pat. No. 8,608,045;

U.S. patent application Ser. No. 12/647,100, entitled MOTOR-DRIVENSURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROLASSEMBLY, filed Dec. 24, 2009, now U.S. Pat. No. 8,220,688;

U.S. patent application Ser. No. 12/893,461, entitled STAPLE CARTRIDGE,filed Sep. 29, 2012, now U.S. Pat. No. 8,733,613;

U.S. patent application Ser. No. 13/036,647, entitled SURGICAL STAPLINGINSTRUMENT, filed Feb. 28, 2011, now U.S. Pat. No. 8,561,870;

U.S. patent application Ser. No. 13/118,241, entitled SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat.No. 9,072,535;

U.S. patent application Ser. No. 13/524,049, entitled ARTICULATABLESURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed on Jun. 15, 2012,now U.S. Pat. No. 9,101,358;

U.S. patent application Ser. No. 13/800,025, entitled STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013, now U.S. Pat.No. 9,345,481; U.S. patent application Ser. No. 13/800,067, entitledSTAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013,now U.S. Patent Application Publication No. 2014/0263552;

U.S. Patent Application Publication No. 2007/0175955, entitled SURGICALCUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM,filed Jan. 31, 2006; and

U.S. Patent Application Publication No. 2010/0264194, entitled SURGICALSTAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed Apr. 22,2010, now U.S. Pat. No. 8,308,040, are hereby incorporated by referenceherein.

Although various devices have been described herein in connection withcertain embodiments, modifications and variations to those embodimentsmay be implemented. Particular features, structures, or characteristicsmay be combined in any suitable manner in one or more embodiments. Thus,the particular features, structures, or characteristics illustrated ordescribed in connection with one embodiment may be combined in whole orin part, with the features, structures or characteristics of one oremore other embodiments without limitation. Also, where materials aredisclosed for certain components, other materials may be used.Furthermore, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Theforegoing description and following claims are intended to cover allsuch modification and variations.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, a device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the stepsincluding, but not limited to, the disassembly of the device, followedby cleaning or replacement of particular pieces of the device, andsubsequent reassembly of the device. In particular, a reconditioningfacility and/or surgical team can disassemble a device and, aftercleaning and/or replacing particular parts of the device, the device canbe reassembled for subsequent use. Those skilled in the art willappreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

The devices disclosed herein may be processed before surgery. First, anew or used instrument may be obtained and, when necessary, cleaned. Theinstrument may then be sterilized. In one sterilization technique, theinstrument is placed in a closed and sealed container, such as a plasticor TYVEK bag. The container and instrument may then be placed in a fieldof radiation that can penetrate the container, such as gamma radiation,x-rays, and/or high-energy electrons. The radiation may kill bacteria onthe instrument and in the container. The sterilized instrument may thenbe stored in the sterile container. The sealed container may keep theinstrument sterile until it is opened in a medical facility. A devicemay also be sterilized using any other technique known in the art,including but not limited to beta radiation, gamma radiation, ethyleneoxide, plasma peroxide, and/or steam.

While this invention has been described as having exemplary designs, thepresent invention may be further modified within the spirit and scope ofthe disclosure. This application is therefore intended to cover anyvariations, uses, or adaptations of the invention using its generalprinciples.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdo not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A surgical stapler for stapling the tissue of apatient, comprising: a handle; a shaft extending from said handle; anend effector, comprising: a tissue compression surface; and an anvilcomprising staple forming pockets, wherein said anvil is movable towardsaid tissue compression surface during a closing motion; an anvilclosing system configured to move said anvil through said closingmotion; and a propulsion system, comprising: a first foot configured toengage the patient tissue and move said end effector relative to thepatient tissue during a first propulsion stroke; and a second footconfigured to engage the patient tissue and move said end effectorrelative to the patient tissue during a second propulsion stroke.
 2. Thesurgical stapler of claim 1, wherein said propulsion system isconfigured to repetitively sequence said first propulsion stroke andsaid second propulsion stroke, whereby said propulsion system can walksaid end effector relative to the patient tissue.
 3. The surgicalstapler of claim 1, wherein said propulsion system is configured tocomplete said first propulsion stroke before beginning said secondpropulsion stroke.
 4. The surgical stapler of claim 1, wherein saidpropulsion system is configured to at least partially complete saidfirst propulsion stroke before beginning said second propulsion stroke.5. The surgical stapler of claim 1, wherein said propulsion systemcomprises means for synchronizing said first propulsion stroke and saidsecond propulsion stroke.
 6. The surgical stapler of claim 1, whereinsaid end effector further comprises a staple cartridge comprising aplurality of staples.
 7. The surgical stapler of claim 6, furthercomprising a staple firing system configured to deploy said staplesduring a staple firing stroke.
 8. The surgical stapler of claim 7,wherein said propulsion system comprises synchronizing means forperforming said closing motion after said first propulsion stroke andsaid second propulsion stroke have both been performed.
 9. The surgicalstapler of claim 8, wherein said synchronizing means performs saidstaple firing stroke after said closure stroke has been performed. 10.The surgical stapler of claim 9, wherein said synchronizing meansincludes a mechanism.
 11. The surgical stapler of claim 9, wherein saidsynchronizing means comprises a controller including a microprocessor.12. The surgical stapler of claim 1, wherein said propulsion system isconfigured to perform said first propulsion stroke and said secondpropulsion stroke at the same time.
 13. The surgical stapler of claim 1,wherein said propulsion system is configured to perform said firstpropulsion stroke to steer said end effector in a first direction andsaid second propulsion stroke to steer said end effector in a seconddirection.
 14. The surgical stapler of claim 1, further comprising avacuum system in communication with at least one of said first foot andsaid second foot, wherein said vacuum system is configured to hold thepatient tissue within said end effector utilizing said vacuum system.15. The surgical stapler of claim 1, wherein said first foot comprises afirst rotatable element and said second foot comprises a secondrotatable element.
 16. The surgical stapler of claim 1, wherein saidfirst foot comprises a first set of teeth configured to grip the patienttissue and said second foot comprises a second set of teeth configuredto grip the patient tissue.
 17. The surgical stapler of claim 1, whereinsaid first foot comprises a first translatable element and said secondfoot comprises a second translatable element.
 18. The surgical staplerof claim 1, wherein said first foot comprises a first base and a firstextendable portion which is extendable relative to said first base, andwherein said second foot comprises a second base and a second extendableportion which is extendable relative to said second base.
 19. A surgicalstapler for stapling the tissue of a patient, comprising: a handle; ashaft extending from said handle; an end effector, comprising: a tissuecompression surface; and an anvil comprising staple forming pockets,wherein said anvil is movable toward said tissue compression surfaceduring a closing motion; an anvil closing system configured to move saidanvil through said closing motion; and a tissue advancement systemcomprising a foot configured to engage the patient tissue and pull thepatient tissue relative to said end effector during a tissue advancementstroke.
 20. A surgical stapler for stapling the tissue of a patient,comprising: a handle; a shaft extending from said handle; a plurality ofstaple cartridges; an end effector, comprising: a tissue compressionsurface; and an anvil comprising staple forming pockets, wherein saidanvil is movable toward said tissue compression surface during a closingmotion; an anvil closing system configured to move said anvil throughsaid closing motion; a staple firing system configured to deploy saidstaple cartridges along a path; and means for gripping the patienttissue and creating relative movement between said end effector and thepatient tissue to re-position said end effector along said path.